Risk factors for low bone density in pediatric nephrotic syndrome

Main Article Content

Corina Lisa
Madarina Julia
Pungky A. Kusuma
Tonny Sadjimin

Abstract

Background Disturbances in bone mineral metabolism and side effects of corticosteroid treatment may cause decreased bone density in patients v.ith nephrotic syndrome (NS).

Objectives To compare the prevalence oflow bone mineral density (BMD) in children with and 'Without NS and to assess the effect of corticosteroid treatment on bone density in NS patients. 

Methods We conducted a retrospective, cohort study in children aged 5-18 years diagnosed 'With NS for more than 2 months prior to data collection, and in children v.ithout NS as a control. BMD was assessed on calcaneal bone wlith ultrasound bone densitometry. Serum calcium, albumin, creatinine and phosphate levels were also assessed.

Results The prevalence of low BMD was significantly higher in NS patients than non􀁂NS subjects, 73.3% (22 in 30) vs. 33% (11 in 33), respectively. The prevalence ratio was 6.3 (95% CI 2.1 to 18.9). NS patients had lower serum calcium levels, With mean difference of -0.17 (95% CI -0.27 to -0.07 mMollL), P<0.009, and lower serum albumin, with mean difference of  -0.88 (95% CI -1.27 to -0.49 gIL); P<O.OO 1, than non􀁂NS subjects. After adjusting for other risk factors, we found NS to be an independent risk factor for low BMD. Steroid-resistant and steroid-dependent patients had lower BMD than steroid-sensitive subjects (P=0.02). There was also a significant correlation between the onset of corticosteroid treatment and BMD (r=O.3; P=0.02).

Conclusions NS patients had higher risk for low BMD compared to normal subjects. Response to steroid treatment influences the severity of impaired bone density.

Article Details

How to Cite
1.
Lisa C, Julia M, Kusuma P, Sadjimin T. Risk factors for low bone density in pediatric nephrotic syndrome. PI [Internet]. 30Apr.2011 [cited 15Jun.2021];51(2):61-. Available from: https://paediatricaindonesiana.org/index.php/paediatrica-indonesiana/article/view/888
Section
Articles
Received 2016-10-12
Accepted 2016-10-12
Published 2011-04-30

References

1. Freundlich M, Bourgoignie D, Zilleruelo JJ, Jacob G, Cantenbury A, Strauss JM. Bone modulating factors in nephrotic children Mth nonnal glomerular filtration rate. Pediatrics. 1985;76.280·5.
2. Weng FL, Shults J, Herskovitz RM, Zemel BS, Leonard MB. Vitamin D insufficiency in steroid sensitive nephrotic syndrome in remission. Pediatr Nephrol. 2005;20:56-63.
3. Gulati S, Godbole M, Sing U, Gulati K, Srivastava A. Are children with idiopathic nephrotic syndrome at risk for metabolic bone disease? Am J Kidney Dis. 2003;41:1163-9.
4. Grymonprez A, Proesmans W, Van Dyckl M, J ans I, Goos G, Bouillon R. Vitamin D metabolites in childhood nephrotic syndrome. Pediatr Nephrol. 1995;9;278·81.
5. Mittal SK, Dash SC, Tiwari SC, Agarwal SK. Bone histology in patients with nephrotic syndrome and normal renal function. Kidney Int. 1999;5 :1912-9.
6. DeLuca HF. Vitamin D endocrinol ogy. Ann Intern Med. 1976;85.367·77.
7. Lyman D. Undiagnosed vitamin D deficiency in the hospitalized patient. Am Fam Physician. 2005;71:299-304.
8. Prummel MF, Wiersinga WM, Ups P, Sanders GT, Sauerwein HP. The course of biochemical parameters of bone turnover during treatment with corticosteroids. J Clin Endocrinol Metab. 1991;72.382·6.
9. Biyikli NK, Emre S, Sirin A, Bilge I. Biochemical bone markers in nephrotic children. Pediatr Nephrol. 2004;15:35-7.
10. Freundlich M, Jofe M, Goodman WG, Salusky lB. Bone histology in steroid􀁞treated children with non􀁞azotemic nephrotic syndrome. Pediatr N ephrol. 2004; 19 :400-7.
11. Shouman MG, Abdallah N, Meguid AE, Salama EEE, El Ghoroury E, Abou􀁞 Ismail LA, et al. Bone mineral density markers in children Mth steroid sensitive idiopathic nephrotic syndrome. Int J Acad Res. 2010;2.150·5.
12. DeDeus BR, Ferreira ZA, Kirstajn GM, Hedberg IP. Osteopenia in patients with glomerular disease requiring long-term corticosteroid therapy. Nephron Clin Pract. 2003;94:c69-74.
13. Basitrania M, Fallahzadeh MH, Derakhshan A, Hosseini-Al-Hashemi G. Bone mineral density in children Mth relapsing nephrotic syndrome. Iran J Med Sci. 2006;31:82-6.
14. Mushtaq T, Ahmed SF. The impact of corticosteroids on growth and bone health. Arch Dis Child. 2002;87:93-6.
15. Freundlich M, Bourgoignie JJ, Zilleruelo G. Calcium and vitamin D metabolism in children with nephrotic syndrome. J Pediatr. 1986;108:383-7.
16. Bagga, A. Revised guidelines for management steroid sensitive nephrotic syndrome. Indian J N ephrol. 2008;18:31-9.
17. 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.
18. Gulati S, Shanna RK, Gulati K, Singh U, Srivastava A. Longitudinal follow􀁞up of bone mineral density in children with nephrotic syndrome and the role of calcium and vitamin D supplements. Nephrol Dial Transplant. 2005;20:1598-603.
19. MishraOp, MeenaSK, Singh SK, Prasad R, Mishra RN. Bone mineral density in children Mth steroid􀁞sensitive nephrotic syndrome. Indian J Pediatr. 2009;76.1237·9.
20. Esbjorner E, Arvidsson B,Jones IL, Palmer M. Bone mineral content and collagen metabolites in children receiving steroid treatment for nephrotic syndrome. Acta Pediatr. 2001;90:1127-30.