Effect of calcium and vitamin D supplementation on serum calcium level in children with idiopathic nephrotic syndrome
Abstract
Background Patients with idiopathic nephrotic syndrome (NS) may
develop hypocalcemia caused by low levels of albumin and vitamin
D -binding protein, which subsequently decreases calcium absorption
in the intestine. Hypocalcemia may result in neuromuscular
manifestations, such as Chvostek's and Trosseau's signs.
Objectives To evaluate the effect of calcium and vitamin D
supplementation on hypocalcemia and its clinical manifestations
in idiopathic NS children.
Methods A randomized, single-blind, controlled trial was
performed in idiopathic NS patients aged 1-14 years. Subjects
were divided into treatment and placebo groups. Subjects in
the treatment group received 800 mg elemental calcium and
400 IU vitamin D supplementation, while they in control group
received placebo syrup, both for 8 weeks. Serum calcium and
manifestations of hypocalcemia were examined before and after
supplementation.
Results Thirty subjects completed the study (15 in each group).
Seventeen subjects experienced hypocalcemia. Chvostek's and
Trosseau's signs were observed in 6 subjects in the treatment group
and 2 subjects in the placebo group (P= 0.427). After 8 weeks of
intervention, Chvostek's and Trosseau's signs disappeared in both
groups, and calcium levels were significantly increased in both
groups compared to the levels before intervention. However, there
was no significant difference in serum calcium levels after 8 weeks
between the treatment and placebo groups (P =0.707).
Conclusion Normalization of serum calcium levels and improved
clinical manifestations ofhypocalcemia occur both in NS patients
who receive calcium and vitamin D supplementation and those
who do not.
References
Peacock M. Calcium metabolism in health and disease. Clin J Am Soc Nephrol. 2010;5:S23-30.
Guyton A. Textbook of medical physiology. Philadelphia: Elsevier; 2005. p. 983-5.
Ismail N. Endocrine dysfunction in the nephrotic syndrome. 2012 Feb; [cited 2013 Jan 24]. Available from: http://www.uptodate.com.
Gamiasih D. Hubungan antara kadar albumin clan kalsium serum pada sindrom nefrotik anak. Sari Pediatri. 2008;10:100-5.
Lisa C, Julia M, Kusuma PA, Sadjimin T. Risk factors for low bone density in pediatric nephrotic syndrome. Paediatr Indones. 2011;51:61-5.
Septarini AD, Tambunan T, Amalia P. Calcium and vitamin D supplementation in children with frequently relapsing and steroid-dependent nephrotic syndrome. Paediatr Indones. 2012;52:16-21.
Winata VI, Gurnida DA, Sekarwana N. Relationship between ionized calcium and serum albumin level in children with idiopathic nephrotic syndrome. Paediatr Indones. 2010;50:361-4.
Fong J, Khan A. Hypocalcemia : updates in diagnosis and management for primary care. Can Fam Physician. 2012;58:158-62.
Shaw N. A practical approach to hypocalcaemia in children. Endocr Dev. 2009;16:73-92.
Goltzman D. Clinical manifes tations of hypocalcemia. 2012 May; [cited 2013 Jan 24]. Available from: http://www.uptodate.com.
Bak M, Serdaroglu E, Guclu R. Prophylactic calcium and vitamin D treatments in steroid-treated children with nephrotic syndrome. Pediatr Nephrol. 2006;21:350-4.
Schwartz GJ, Work DF. Measurement and estimation of GFR in children and adolescents. Clin J Am Soc Nephrol.2009;4:1832-43 .
Alatas H, Tambunan T, Trihono P, Pardede S. Konsensus tata laksana sindrom nefrotik idiopatik pada anak. Jakarta: Unit Kerja Koordinasi Nefrologi Ikatan Dokter Anak Indonesia; 2008. p. 1-20.
Eddy AA, Symons JM. Nephrotic syndrome in childhood. Lancet. 2003;362:629-39.
Abeyagunawardena AS. Treatment of steroid sensitive nephrotic syndrome. Indian J Pediatr. 2005;72:763-9.
Kosan C, Ayar G, Orbak Z. Effects of steroid treament on bone mineral metabolism in children with glucocorticoid-sensitive nephrotic syndrome. West Indian Med J. 2012;61:627-30.
Huybers S, Naber TH, Bindels RJ, Hoenderop JG. Prednisolone-induced Ca2 + malabsorption is caused by diminished expression of the epithelial Ca2+ channel TRPV6. Am J Physiol Gastrointest Liver Physiol. 2007;292:G92-7.
Bagga A, Mantan M. Nephrotic syndrome in children. Indian J Med Res. 2005;122:13-28.
No author listed. Vitamin D. Alt Med Rev. 2008;13:153-64.
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Accepted 2016-09-09
Published 2014-06-30
