Change in Bone Mineral Density and Role of Vitamin D and Calcium Supplementation During Treatment of First Episode Nephrotic Syndrome

Yadav, Veejendra K.; Sharma, Shobha; Debata, Pradeep; Patel, Seema; Kabi, B C; Aggrawal, Kailash Chandra

doi:10.7860/jcdr/2017/27030.10657

Cited by 7 publications

(10 citation statements)

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“…We found that higher cumulative dose of steroids was associated with decreased BMD Z-scores and osteoporosis, as in similar studies, 19,33 in addition to low total calcium intake and older age of onset. 34 Other studies did not find such association, 20,21 which may be due to small sample size, variable characteristics of participants and disease, wide age range and variable exposure to steroids.…”

Section: Discussionmentioning

confidence: 94%

“…The role of vitamin D and changes in BMD has been well documented in the literature. 34 Vitamin D deficiency in India is known to be widespread, and is an essential nutrient for optimal bone growth; potential adverse effects of over dosage supplementation must be kept in mind. 35,36 Our study supports the evidence that children with INS are at increased risk for osteoporosis.…”

Section: Discussionmentioning

confidence: 99%

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Bone mineral density and its influencing factors in children with idiopathic nephrotic syndrome: a prospective observational study

et al. 2019

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Glucocorticoids are first-line therapy for children with idiopathic nephrotic syndrome (INS). These children are at risk of deranged bone metabolism and low bone mineral density (BMD). We studied 60 children with INS and divided them into two groups. Group 1 included 21 children (initial and infrequent relapsing) and group 2 included 39 children (frequent relapsing, steroid dependent and steroid resistant). Dual-energy X-ray absorptiometry of the lumbar spine was performed to assess BMD. Mean BMD Z-score was compared in both groups; this correlated significantly on univariate analysis with cumulative steroid dose, serum vitamin D levels and calcium supplementation. However, on multivariate analysis, serum vitamin D level was the only factor significantly predictive of low z-score.

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Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 99%

Bone mineral density and its influencing factors in children with idiopathic nephrotic syndrome: a prospective observational study

et al. 2019

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“…In both the 2012 KDIGO guideline and the Dutch clinical practice guideline, there is no mention of vitamin D supplementation. In 2017, Yadav et al [ 31 ] showed a decrease in bone mineral density with steroid treatment and a beneficial role of calcium and vitamin D supplementation even during the first episode of nephrotic syndrome. Nevertheless, the optimal dose, frequency of administration, and duration remain to be elucidated [ 32 ].…”

Section: Discussionmentioning

confidence: 99%

Practice variations in the management of childhood nephrotic syndrome in the Netherlands

et al. 2021

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Nephrotic syndrome in childhood is a common entity in the field of pediatric nephrology. The optimal treatment of children with nephrotic syndrome is often debated. Previously conducted studies have shown significant variability in nephrotic syndrome management, especially in the choice of steroid-sparing drugs. In the Netherlands, a practice guideline on the management of childhood nephrotic syndrome has been available since 2010. The aim of this study was to identify practice variations and opportunities to improve clinical practice of childhood nephrotic syndrome in the Netherlands. A digital structured survey among Dutch pediatricians and pediatric nephrologists was performed, including questions regarding the initial treatment, relapse treatment, kidney biopsy, additional immunosuppressive treatment, and supportive care. Among the 51 responses, uniformity was seen in the management of a first presentation and first relapse. Wide variation was found in the tapering of steroids after alternate day dosing. Most pediatricians and pediatric nephrologists (83%) would perform a kidney biopsy in case of steroid-resistant nephrotic syndrome, whereas for frequent relapsing and steroid-dependent nephrotic syndrome this was 22% and 41%, respectively. Variation was reported in the steroid-sparing treatment. Finally, significant differences were present in the supportive treatment of nephrotic syndrome.Conclusion: Substantial variation was present in the management of nephrotic syndrome in the Netherlands. Differences were identified in steroid tapering, use of steroid coverage during stress, choice of steroid-sparing agents, and biopsy practice. To promote guideline adherence and reduce practice variation, factors driving this variation should be assessed and resolved. What is Known:• National and international guidelines are available to guide the management of childhood nephrotic syndrome.• Several aspects of the management of childhood nephrotic syndrome, including the choice of steroid-sparing drugs and biopsy practice, are controversial and often debated among physicians.What is New:• Significant practice variation is present in the management of childhood nephrotic syndrome in the Netherlands, especially in the treatment of FRNS, SDNS, and SRNS.• The recommendation on the steroid treatment of a first episode of nephrotic syndrome in the KDIGO guideline leaves room for interpretation and is likely the cause of substantial differences in steroid-tapering practices among Dutch pediatricians and pediatric nephrologists.

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“…However a few longitudinal studies of steroid use have reported similar or different results. Two months 20 , three months [21][22][23] and one year 24 of steroid therapy has been shown to negatively affect BMD LS. In contrast BMC and BMD were increased after one year 19,21 or two years 27 of steroid use.…”

Section: Discussionmentioning

confidence: 99%

“…A few studies have reported association of cumulative dose of steroids with BMD [6][7][8][9][10] and some revealed no association [16][17] . Few longitudinal studies have assessed the effect of steroids on bone health and most of these have been done on patients receiving steroids for three months or less [20][21][22][23] or more than 6 months 19,[24][25][26][27] . No study has been reported in the literature assessing the effect of steroids of 3 to 6 months duration on BMD.…”

Section: Introductionmentioning

confidence: 99%

Effects of 3 to 6 months of systemic glucocorticoids on bone mineral density in children

Kukreja

Pal

Sachdev

et al. 2021

Sri Lanka J Child Health

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Introduction: Studies on the effects of systemic steroids on bone mineral density (BMD) in children have shown conflicting results. Objectives:To measure the effect of 3-6 months of systemic glucocorticoids on BMD in children. Method:Thirty cases (20 nephrotic syndrome, 7 systemic lupus erythematosus and 3 juvenile dermatomyositis) and 30 age and sex matched controls were recruited. Dual energy x-ray absorptiometry of whole body (WB), lumbar spine (LS) and non-dominant distal radius (DR) were done at baseline and at the end of steroid therapy for cases and controls. Total body less head (TBLH) values were derived from WB values. For analysis, age and sex adjusted values of bone densitometric parameters were used. Student t-test or Mann-Whitney U-test was used to compare baseline data and paired t-test or Wilcoxon signedrank test to compare patient data. Correlations were determined by Pearson and Spearman correlation coefficients. p <0.05 was taken as significant.Results: Mean cumulative dose and duration of steroids were 217.99mg/kg and 124.23 days respectively. After steroid therapy, bone mineral content (BMC) of WB, TBLH, LS and DR decreased by 8.9%, 6.3%, 6% and 8.4% respectively whereas BMD decreased by 18%, 9.8%, 12% and 3.3% respectively. The decrease was statistically significant for BMD WB (p=0.005), DR (p=0.004) and LS (p=0.001) as well _________________________________________ 1

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Change in Bone Mineral Density and Role of Vitamin D and Calcium Supplementation During Treatment of First Episode Nephrotic Syndrome

Cited by 7 publications

References 14 publications

Bone mineral density and its influencing factors in children with idiopathic nephrotic syndrome: a prospective observational study

Bone mineral density and its influencing factors in children with idiopathic nephrotic syndrome: a prospective observational study

Practice variations in the management of childhood nephrotic syndrome in the Netherlands

Effects of 3 to 6 months of systemic glucocorticoids on bone mineral density in children

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