SAT-313 EFFECT OF NORMALIZATION OF 25 (OH) VITAMIN D LEVELS ON FREQUENCY OF RELAPSES IN FIRST YEAR OF CHILDHOOD NEPHROTIC SYNDROME A NON RANDOMIZED CONTROLLED TRIAL

Abstract

Low 25 (OH) Vitamin D levels have been described in childhood nephrotic syndrome (NS) due to nutritional deficiency and loss of vitamin D binding proteins in the urine. This study was done to detect the prevalence of 25(OH) D deficiency in children with the first attack of NS and to evaluate the impact of normalizing 25(OH) D levels on the number and frequency of relapses in the first year following the initial attack of NS. Children presenting with first episode of NS were treated with standard steroid regime for 12 weeks. Steroid sensitivity (SSNS) was assessed at the end of 4 weeks of daily therapy. SSNS were included in the study. 25(OH) Vitamin D was estimated. Levels =/>30 ng/ml were considered adequate. Oral cholecalciferol 60,000 units daily for 10 days was given if levels were < 10ng/ml and 60,000 units daily for 5 days for levels >10ng/ml but < 30ng/ml. Levels were estimated again at 12 weeks and if still low, a similar second course was given. Patients not willing to test 25(OH) D were followed up as control. All patients received daily maintenance cholecalciferol (1000 IU/day) and calcium supplements and were followed up for a period of one year. Time to first relapse, number of relapses in one year, number of relapses in the first and second six months and the number of infection associated relapses were studied. The sample size was calculated for alpha of 0.05 with power of 80% and relative risk of 0.4. The number required in each arm was 44. 97 children presented with the first attack of NS. At 4 weeks, 4 patients were excluded (2 steroid resistant; 2 lost to follow up). Of these, 45 who underwent estimation of serum 25(OH) D levels were included in the study group; 48 who refused evaluation were followed up as controls. 44 /45 patients (93.75%) in the study group had 25(OH) D levels < 30ng/ml at 4 weeks; 24 (54%) had deficiency (<10ng/ml) and 20 (44%) had insufficiency (10-30ng/ml). The mean level of 25(OH) D at 4 weeks was 11.11+/-7.023 ng/ml and at 12 weeks was 37.73+/- 18.38ng/ml. The two groups were comparable in age and sex. There was no significant difference between the two groups in time to first relapse, relapse rates, number of relapses in the first and second six months, total number of relapses or infection associated relapses. (Table 1) Table 1 Relapses in children with normalized 25(OH)D levels compared to standard therapyTabled 1ParameterStudy group (n=45) Mean and Standard deviationControl (n=48) Mean and Standard deviationSignificanceAge (years)4.50 +/- 2.693.80 +/- 2.750.057Males28 (68.3%)28 (52.2%)0.72Time to first relapse (months)8.38 +/5.079.53 +/- 5.960.428Relapse rate1.77 +/- 1.751.68+/- 1.870.809No of relapses in first 6 months0.39+/- 0.750.38+/- 0.680.923No of relapses in 6 months -1year0.76+/- 0.800.64+/-0.740.497Total relapses in first year1.20+/- 1.470.81+/-1.070.200No of Frequent relapsers10 (22.2%)11 (22.9%)0.052No of Infection associated relapses in first 6 months0.09 +/- 0.290.04+/- 0.200.374In next 6 months0.20+/- 0.460.21+/-0.380.700 Open table in a new tab Low 25(OH)D levels were found in 93% of children with SSNS. Early restoration of 25(OH) D levels to normal did not reduce the time to first relapse, the number of relapses in the first year, the number of frequent relapsers or infection associated relapses.