Vitamin D in incident nephrotic syndrome: a Midwest Pediatric Nephrology Consortium study - Pediatric Nephrology

Background

Cross-sectional studies of children with prevalent nephrotic syndrome (NS) have shown 25-vitamin D (25(OH)D) deficiency rates of 20–100 %. Information on 25(OH)D status in incident patients or following remission is limited. This study aimed to assess 25(OH)D status of incident idiopathic NS children at presentation and longitudinally with short-term observation.

Methods

Multicenter longitudinal study of children (2–18 years old) from 14 centers across the Midwest Pediatric Nephrology Consortium with incident idiopathic NS. 25(OH)D levels were assessed at diagnosis and 3 months later.

Results

Sixty-one children, median age 5 (3, 11) years, completed baseline visit and 51 completed second visit labs. All 61 (100 %) had 25(OH)D < 20 ng/ml at diagnosis. Twenty-seven (53 %) had 25(OH)D < 20 ng/ml at follow-up. Fourteen (28 %) children were steroid resistant. Univariate analysis showed that children prescribed vitamin D supplements were less likely to have 25(OH)D deficiency at follow-up (OR 0.2, 95 % CI 0.04, 0.6). Steroid response, age, and season did not predict 25(OH)D deficiency. Multivariable linear regression modeling showed higher 25(OH)D levels at follow-up by 13.2 ng/ml (SE 4.6, p < 0.01) in children supplemented with vitamin D.

Conclusions

In this incident idiopathic NS cohort, all children at diagnosis had 25(OH)D deficiency and the majority continued to have a deficiency at 2–4 months. Supplemental vitamin D decreased the odds of 25(OH)D deficiency at follow-up, supporting a role for supplementation in incident NS.

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The investigators are indebted to the children and families who graciously participated in this study. This work was supported by a grant from the Renal Research Institute. M.E.S. was supported by the Washington University Institute of Clinical and Translational Sciences grants UL1 TR000448 and KL2 TR000450 from NIH/NCATS, and L40 DK099748 from NIH/NIDDK. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

Conflict of interest

The author(s) declare that they have no competing interests.

Authors and Affiliations

1. Division of Nephrology, Department of Pediatrics and Communicable Diseases, C.S. Mott Children’s Hospital, University of Michigan, Ann Arbor, MI, USA

   David T. Selewski, Jonathan P. Troost & Debbie S. Gipson

2. Department of Pediatrics, Section of Pediatric Nephrology, Wake Forest Baptist Health, Winston-Salem, NC, USA

   Ashton Chen

3. Division of Pediatric Nephrology and Hypertension, Sidra Medical and Research Center, Doha, Qatar

   Ibrahim F. Shatat

4. Medical University of South Carolina, Charleston, SC, USA

   Ibrahim F. Shatat

5. Department of Pediatric Nephrology, St. John’s Medical College Hospital, St John’s National Academy of Health Sciences, Bangalore, India

   Priya Pais

6. Emory University and Children’s Healthcare of Atlanta, Atlanta, GA, USA

   Larry A. Greenbaum

7. Division of Nephrology, Department of Pediatrics, Children’s Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON, Canada

   Pavel Geier

8. Division of Nephrology, Department of Pediatrics, University of Utah, Salt Lake City, UT, USA

   Raoul D. Nelson

9. Department of Pediatrics, University of Kentucky, Lexington, KY, USA

   Stefan G. Kiessling

10. Stead Family Department of Pediatrics, Division of Nephrology, University of Iowa, Iowa City, IA, USA

    Patrick D. Brophy

11. DeVos Children’s Hospital, Grand Rapids, MI, USA

    Alejandro Quiroga

12. Division of Pediatric Nephrology, Department of Pediatrics, Washington University at St. Louis, St. Louis, MO, USA

    Michael E. Seifert

13. Department of Pediatrics, Southern Illinois University, Springfield, IL, USA

    Michael E. Seifert

14. Department of Pediatrics, Louisiana State University and Children’s Hospital, New Orleans, LA, USA

    Caroline E. Straatmann

15. Nationwide Children’s Hospital, The Ohio State University, College of Medicine, Columbus, OH, USA

    John D. Mahan

16. Pediatric Nephrology, UNC Kidney Center, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

    Maria E. Ferris

Corresponding author

Correspondence to David T. Selewski.