Study On Different Doses Of Glucocorticoid And Vitamin D Supplementation In Children With Primary Nephrotic Syndrome

BackgroundPrimary nephrotic syndrome is one of the common kidney diseases in children.Glucocorticoids are recognized as first-line treatments by Nephrotic syndrome.It can cause side effects such as osteoporosis,obesity,high blood pressure,and diabetes.Glucocorticoids also cause a decrease in the production of 25(OH)D and 1,25(OH)D by directly affecting the expression of 24 hydroxylase.Vitamin D is an important component of bone metabolism and calcium homeostasis,and vitamin D supplements are the basic treatment for osteoporosis.In addition,vitamin D deficiency is also associated with diseases such as diabetes,hypertension,inflammatory bowel disease,malignant tumors and asthma.Therefore,this article aims to explore the relationship between the application different doses of glucocorticoids and vitamin D supplementation in children with primary nephrotic syndrome,in order to guide clinical treatment.ObjectiveTo study the correlation between glucocorticoid administration and vitamin D supplementation in children with primary nephrotic syndrome.MethodsA retrospective analysis of 104 children with primary nephrotic syndrome during the remission period from December 2016 to December 2018 in the First Affiliated Hospital of Xinxiang Medical University,according to the dose of glucocorticoid in children.Divided into group A,group B,group C.62 patients in group A received glucocorticoid ≤ 1mg/kg every other morning;38 patients in group B,glucocorticoids>1mg/kg,≤2mg/kg every other morning;4 cases in group C,daily morning after taking the glucocorticoids 2mg/kg,the statistical analysis was impossible because the sample size of the C group was too small.The vitamin D adequacy ratio(500 IU,600 IU,700 IU)was evaluated by daily supplementation with different doses of vitamin D.In group A,2 patients with vitamin D 200 IU/day were supplemented;in group B,vitamin D supplemented with 1000 IU/day.One patient had a small number of cases and was not included in the experimental group.According to the level of serum 25(OH)D,the state of vitamin D in the body was judged,vitamin D < 30 ng / ml was insufficient,and ≥ 30 ng / ml was sufficient.Results1.There were 60 patients in group A,including 53 males and 7 females,aged(5.99±2.91)years;There were 37 cases in group B,including 31 males and 6 females,aged(5.31±2.78)years.2.In group A,vitamin D adequacy ratios of 500 IU/d,600 IU/d and 700 IU/d were 44.4%,57.6% and 88.9%,respectively.In group B,vitamin D adequacy ratios of 500 IU/d,600 IU/d and 700 IU/d were 20%,57.1% and 69.2%,respectively.In group A,the vitamin D adequacy ratios of 700 IU,500IU and 600 IU supplemental daily were compared,and the differences were statistically significant(P < 0.05).There was no statistically significant difference between the vitamin D adequacy ratio supplemented with 500 IU and 600IU(P > 0.05).In group B,there was no statistically significant difference between 600IU/d and 500IU/d,700IU/d(P >0.05).The difference between the supplementation of 500 IU and 700 IU was statistically significant(P < 0.05).There was no significant difference between the two groups in vitamin D supplementation at the same dose(P > 0.05).3.In group A,serum 25(OH)D levels of the children supplemented with vitamin D at 500IU/d,600IU/d,and 700IU/d were 29.594±9.139 ng/ml,31.688±8.483 ng/ml,and 37.105±9.834ng/ml,respectively.In group B,serum 25(OH)D levels were 26.450±5.450 ng/ml,32.164±8.089 ng/ml,32.582±7.978ng/ml in children receiving vitamin D supplementation at 500IU/d,600IU/d,and 700IU/d,respectively.In group A,there was no statistically significant difference between the supplement of 500IU/d and the supplement of 600IU/d and 700IU/d(P > 0.05).The difference between the supplement of 600IU/d and the supplement of 700IU/d was statistically significant(P < 0.05).In group B,there were no statistically significant differences in vitamin D supplementation at different doses(P >0.05).At the same dose of vitamin D,there was no significant difference between the two groups(P > 0.05).Conclusions1.Serum 25(OH)D level in children with primary nephrotic syndrome remission was lower than normal.2.In primary nephrotic syndrome remission period,when glucocorticoid 1mg/kg is taken in the morning of the next day,at least 700 IU of vitamin D should be supplemented every day to maintain adequate serum vitamin D level in children with nephrotic syndrome.3.In primary nephrotic syndrome remission period,when the glucocorticoid > 1mg/kg,2mg/kg is taken in the morning of the next day,at least 700 IU of vitamin D should be supplemented every day to maintain adequate serum vitamin D level in children with nephrotic syndrome.