Assessment of the Concentration of Bone Metabolism Markers: Sclerostin and FGF-23 in Children with Idiopathic Nephrotic Syndrome Treated with Glucocorticosteroids.

Agnieszka Pukajło-Marczyk,Katarzyna Kiliś-Pstrusińska,Agnieszka Bargenda-Lange,Anna Jakubowska,Danuta Zwolińska

doi:10.1155/2019/9698367

Agnieszka Pukajło-Marczyk, Katarzyna Kiliś-Pstrusińska + Show 3 more

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https://doi.org/10.1155/2019/9698367

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Journal: Disease markers	Publication Date: Jul 1, 2019
Citations: 2	License type: CC BY 4.0

Affiliation: Wroclaw Medical University

Abstract

Recurring nature of idiopathic nephrotic syndrome (INS) and steroid dependence imply a long-term treatment with glucocorticosteroids (GCSs), which increases the risk of bone metabolism disorders. The search for new markers of that process is essential. The aims of this study were to assess the concentrations of sclerostin (Scl) and fibroblast growth factor-23 (FGF-23) in the plasma of children with INS and compare Scl and FGF-23 to existing markers of bone metabolism, mainly parathyroid hormone (PTH). The study involved 70 children, 50 with INS and 20 healthy children. Patients with INS were divided into 4 groups depending on the number of relapses and applied therapy. Significantly higher concentrations of FGF-23 and Scl were found in all patient groups with INS compared to the control group, and increase in the concentrations of examined parameters depending on the number of NS relapses was showed. In patients from the group with numerous relapses, higher concentrations of FGF-23 and Scl in the relapse phase than those in the remission phase were found. We observed positive correlation in these proteins with parathyroid hormone. Positive correlation of FGF-23 and Scl in the examined group was noted. Children having relapsing INS treated with steroids have higher levels of Scl and FGF-23 that can indicate the bone metabolism disorders. The significance of these observations requires further research.

Highlights

In the treatment of idiopathic nephrotic syndrome (INS) in children, glucocorticosteroids (GCSs) remain the medication of choice
The aims of this study were to assess the concentrations of Scl and fibroblast growth factor-23 (FGF-23) in the plasma of children with INS treated with GCS and compare Scl and FGF-23 to existing markers of bone metabolism, mainly parathyroid hormone (PTH)
Group I is comprised of children with first occurrence of INS treated with GCS (2 mg/kg/24 h); group II is INS children during relapse, with the number of relapses from 4 to 8, treated only with GCS (2 mg/kg/24 h); group III is INS patients with more than 8 relapses, treated with corticosteroid-sparing agents and GCS (2 mg/kg/24 h); and group IV is children in remission treated with corticosteroidsparing agents and low doses of GCS, with chronic GCS therapy in the past

Summary

Introduction

In the treatment of idiopathic nephrotic syndrome (INS) in children, glucocorticosteroids (GCSs) remain the medication of choice. Recurrent nature of this disease and steroid dependence imply a long-term therapy and probably increased risk of bone metabolism disorders. To this time, pediatrics population has not been analyzed in the context of changes in bone parameters during steroid therapy. In the case of long-term steroid treatment, a reduction in the number and impairment of the function of osteoblasts occur [2], which results in the inhibition of bone formation process. GCS suppresses the differentiation of the bone marrow stromal cells in osteoblasts, through inhibiting the signaling pathway of Wnt/B-catenin [3] and through promoting the transformation of stromal cells into adipocytes [4]

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