Calcium, Vitamin D, and Bone Derangement in Nephrotic Syndrome

Samantha Peiling Yang; Lizhen  Ong; Tze Ping  Loh; Horng Ruey  Chua; Cassandra  Tham; Khoo Chin Meng; Lim Pin

doi:10.15605/jafes.036.01.12

Authors

Samantha Peiling Yang National University Hospital and Yong Loo Lin School of Medicine, Singapore https://orcid.org/0000-0003-0838-6721
Lizhen Ong National University Hospital, Singapore
Tze Ping Loh National University Hospital, Singapore
Horng Ruey Chua National University Hospital, Singapore https://orcid.org/0000-0003-1379-0585
Cassandra Tham Yong Loo Lin School of Medicine, Singapore https://orcid.org/0000-0002-9257-5332
Khoo Chin Meng National University Hospital and Yong Loo Lin School of Medicine, Singapore https://orcid.org/0000-0003-1601-2391
Lim Pin National University Hospital and Yong Loo Lin School of Medicine, Singapore

DOI:

https://doi.org/10.15605/jafes.036.01.12

Keywords:

Vitamin D deficiency, hypocalcaemia, bone loss, immune-mediated nephrotic syndrome

Abstract

*Visual Abstracts prepared by Dr. Roy Raoul Felipe

Introduction. Derangement in calcium homeostasis is common in nephrotic syndrome (NS). It is postulated that low serum total calcium and vitamin D levels are due to loss of protein-bound calcium and vitamin D. It is unclear if free calcium and free vitamin D levels are truly low. The guideline is lacking with regards to calcium and vitamin D supplementation in NS. This study aims to examine calcium and vitamin D homeostasis and bone turnover in NS to guide practice in calcium and vitamin D levels supplementation.

Methodology. This is a prospective pilot study of ten patients diagnosed with NS, and eight healthy controls. Calcium, vitamin D, and bone turnover-related analytes were assessed at baseline, partial and complete remission in NS patients and in healthy controls.

Results. NS patients had low free and total serum calcium, low total 25(OH)D, normal total 1,25(OH)D levels and lack of parathyroid hormone response. With remission of disease, serum calcium and vitamin D metabolites improved. However, nephrotic patients who do not attain complete disease remission continue to have low 25(OH)D level.

Conclusion. In this study, the vitamin D and calcium derangement observed at nephrotic syndrome presentation trended towards normalisation in remission. This suggested calcium and vitamin D replacement may not be indicated in early-phase nephrotic syndrome but may be considered in prolonged nephrotic syndrome.

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Author Biographies

Samantha Peiling Yang, National University Hospital and Yong Loo Lin School of Medicine, Singapore

Endocrinology Division, Department of Medicine

Lizhen Ong, National University Hospital, Singapore

Consultant, Department of Laboratory Medicine

Tze Ping Loh, National University Hospital, Singapore

Consultant, Department of Laboratory Medicine

Horng Ruey Chua, National University Hospital, Singapore

Senior Consultant, Nephrology Division

Cassandra Tham, Yong Loo Lin School of Medicine, Singapore

Endocrinology Division

Khoo Chin Meng, National University Hospital and Yong Loo Lin School of Medicine, Singapore

Endocrinology Division, Department of Medicine

Lim Pin , National University Hospital and Yong Loo Lin School of Medicine, Singapore

Endocrinology Division, Department of Medicine

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