Association Of Vitamin D With Primary Nephrotic Syndrome Inchildren

Objective:Case-control studies were conducted to explore the factors affecting serum vitamin D levels in children with newly diagnosed primary nephrotic syndrome,and to observe the benefits of adequate serum vitamin D levels in the treatment of children with hormone-sensitive nephrotic syndrome.Methods:(1)From January 2021 to January 2023,43 children with primary nephrotic syndrome(PNS)and 72 healthy children who were examined in the pediatric department of the Affiliated Hospital of Youjiang Medical College for Nationalities were selected as PNS group and control group,and general data and laboratory indicators 25-hydroxyvitamin D,24-hour urine protein,albumin,total cholesterol,high-density lipoprotein,etc.before glucocorticoid treatment were collected for statistical analysis.(2)From January 2020 to January 2023,231 children with steroid-sensitive nephrotic syndrome(SSNS)who were treated with vitamin D drops in the pediatric follow-up visit of the Affiliated Hospital of Youjiang Medical College for Nationalities from January 2020 to January 2023 were collected,divided into infected group and non-infected group,and the infected group was divided into urine protein-positive group and urine protein-negative group according to the urine protein results in urinalysis.Results:(1)Comparison of general data between PNS group and control group: there were more PNS children in this group than women,29 males(67.4%)and 14 females(32.6%),with a male-to-female ratio of 2.07:1.The mean age of onset was 6.71±3.54 years,the median age was 5.67 years,and the age of onset was mainly preschool children.There were 44 males and28 females in the control group,with a male-to-female ratio of 1.57:1,an age distribution of2.5-14.42 years,and an average age of(6.40±3.37)years.There were no significant differences in age and sex between the two groups(P>0.05)(2)All children with newly diagnosed PNS had vitamin D insufficiency or deficiency when they came to the hospital,vitamin D deficiency accounted for 6.98%,vitamin D deficiency accounted for 93.02%,and the average serum vitamin D level was 9.39±5.46ng/ml.The control group accounted for vitamin D deficiency in 16.67%,vitamin D deficiency accounted for 31.94%,vitamin D adequacy accounted for 51.39%,and the average serum vitamin D level was 32.98±13.78.The serum vitamin D level of children in the PNS group was significantly lower than that in the control group,and the difference was statistically significant(P<0.001).(3)The serum vitamin D level of children in the PNS group was positively correlated with albumin(ρ=0.440,P=0.003)and negatively correlated with 24-hour urinary protein quantity(24h Upro)(ρ=-0.569,P<0.001).(4)There were 231 children with SSNS,96 cases in the infection group,55 cases in males and 41 females,the male-to-female ratio was 1.34:1,the age distribution was 2.08-14.17 years,and the average age was(7.35±2.66)years;There were 135 cases in the non-infected group,75 males and 60 females,with a male-to-female ratio of 1.25,an age distribution of 2.50-14.42 years,and a mean age of(7.74±2.42)years.There were no significant differences in age and sex between the two groups(P>0.05).Vitamin D adequacy was 28 cases in the infection group,and vitamin D insufficiency or deficiency was 68 cases.Vitamin D adequacy was 80 cases in the non-infected group and vitamin D insufficiency or deficiency in 55 cases.There was a statistically significant difference in serum vitamin D levels between the infected and non-infected groups(P<0.001),and the risk of infection was3.53-fold increased in children with SSNS with vitamin D deficiency or deficiency compared with vitamin D-deficient SSNS(OR=3.53,95% CI: 2.02-6.12,P<0.001).(5)A total of 96 cases were in the infection group,39 cases in the urine protein positive group,23 cases in males and 16 females,with an age distribution of 2.08-14.17 years and an average age of(7.42±3.15)years;There were 32 males and 25 females in the urine protein-negative group,with an age distribution of 3.25-11.33 years,and an average age of(7.30±2.30)years,and there was no significant difference in age and age between the two groups(P>0.05).There were 4 cases of vitamin D adequacy in the urine protein-positive group,and 35 cases of vitamin D deficiency or deficiency.There were 24 cases with vitamin D deficiency and 33 cases with vitamin D deficiency in the urine protein-negative group.There was a statistically significant difference in serum vitamin D levels between the urine protein-positive group and the urine-protein-negative group(P=0.001),and the risk of urine protein after infection was6.36-fold increased in children with SSNS with vitamin D deficiency or deficiency compared with vitamin D deficiency or deficiency(OR=6.36,95% CI: 1.99-20.3,P=0.001).Conclusion:(1)The serum vitamin D level of children in the PNS group was significantly lower than that of children in the control group(P<0.001),and the vitamin D deficiency rate was 93.02%.(2)The serum vitamin D level of PNS group was positively correlated with albumin and negatively correlated with 24-hour urine protein.(3)Adequate serum vitamin D levels can reduce the risk of infection in children with SSNS.(4)Adequate serum vitamin D levels can reduce the re-positive of urine protein in children with infected SSNS.