Calcium and vitamin D supplementation in children with frequently relapsing and steroid-dependent nephrotic syndrome

  • Ayi Dilla Septarini Department of Child Health, Faculty of Medicine, University of Indonesia/Cipro Mangunkusumo Hospital, Jakarta, Indonesia.
  • Taralan Tambunan Department of Child Health, Faculty of Medicine, University of Indonesia/Cipro Mangunkusumo Hospital, Jakarta, Indonesia.
  • Pustika Amalia Department of Child Health, Faculty of Medicine, University of Indonesia/Cipro Mangunkusumo Hospital, Jakarta, Indonesia.
Keywords: frequent relapse nephrotic syndrome, steroid dependent, supplementation, calcium, vitamin D, bone mineral density, osteoporosis


Background Children with frequently relapsing and steroiddependent
nephrotic syndrome (FRNS/SDNS) are at risk
for osteoporosis due to impaired metabolism of calcium and
vitamin D.
Objective To determine the effect of calcium and vitamin D
supplementation on bone mineral density, serum ionized calcium
levels and serum 25-hydroxy-vitamin D levels in children with
Methods A clinical trial with a before and after design was
performed. Subjects were SDNS or FRNS pediatric patients 2: 5
years of age. Subjects received 800 mg elemental calcium and 400
IU vitamin D supplementation for 8 weeks. Serum ionized calcium,
serum 25-hydroxy-vitamin D [25(0H)D], and bone mineral density
(BMD) were determined before and after the supplementation.
Results Of the 30 subjects, 28 completed the study. However,
only 20 subjects underwent BMD determination before and after
supplementation. Of the 28 subjects, 22 had hypocalcemia and 26
had low vitamin D levels. Osteopenia was found in 14/20 subjects and
osteoporosis was in 2/20 subjects. After 8 weeks of supplementation,
mean serum ionized calcium increased from low [1.15 mmol/L (SD
O.oJ)] to normal [1.18 mmol/L (SD 0.04)] (P< 0.001) levels, but
mean serum 25(0H)D only increased from vitamin D deficiency
category [20 ng/mL (SD 7 .7)] to vitamin D insufficiency category
[25.5 ng/mL (7.7)] (P=0.010). Mean z-score BMD increased from
-1.1 (SD 0.9) to -0.7 (SD 0.2) after supplementation (P<0.001).
Conclusion Calcium vitamin D supplementation effectively increased
serum ionized calcium, serum 25 (OH)D, and BMD in subjects
with FRNS and SDNS. [Paediatr lndones. 2012;52:16-21].


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How to Cite
Septarini A, Tambunan T, Amalia P. Calcium and vitamin D supplementation in children with frequently relapsing and steroid-dependent nephrotic syndrome. PI [Internet]. 30Mar.2012 [cited 5Mar.2024];52(1):16-1. Available from:
Received 2016-08-21
Accepted 2016-08-21
Published 2012-03-30