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

Introduction: Nephrotic Syndrome (NS) is one of the common illnesses in childhood. Oral glucocorticoids are mainstay of treatment, which are known to cause various short term and long term adverse effects including osteoporosis. Children with first episode and infrequent relapsing NS are not prescribed Calcium (Ca) and Vitamin D (VitD) supplements routinely.

Aim: To observe change in Bone Mineral Density (BMD) in children during first episode of NS and role of VitD and Ca supplementation during the treatment of first episode of NS.

Materials and Methods: A double blind randomized control trial was conducted in Department of Paediatrics at a tertiary care center in New Delhi, India, from October 2011 to March 2013. Three groups were made, each having sample size of 20. Group A (intervention group) consisted of first episode NS patients who received steroids along with VitD and Ca supplements. Group B (placebo group) had children with first episode of NS treated with steroids and placebo. Biochemical tests and BMD assessment were done at start and after three months of steroid treatment. Groupwise differences in BMD, VitD, Ca, Phosphate (PO4 ) and Alkaline Phosphatase (ALP) were assessed at baseline and after three months through Analysis Of Variance (ANOVA). Linear regression models for repeated measures were used to test the association between different variables and BMD and also between various study groups.

Results: Among study population, Group B had significant decrease in VitD levels (28.85±5.52 ng/dl to 14.22±1.36 ng/dl) than to Group A (23.59±6.08 ng/dl to 13.27±1.35 ng/dl) after three months of steroid treatment. Similarly BMD decreased significantly in Group B (-0.033g/cm2 ) as compared to Group A (0.001g/cm2 ) showing significant decrease in VitD and BMD in children with first episode of NS after three months of steroid treatment whereas use of VitD and Ca supplements improves the deficit.

Conclusion: Ca and VitD supplement should be used during treatment of first episode of NS, but further studies are required to ascertain the adequate dose for the same.