SlideShare a Scribd company logo

Nephrotic syndrom and vitamins

losses of both vitamin D binding protein and 25(OH)D in the urine The urinary losses of vitamin D binding protein may be secondary to proteinuria. Deficiency in 25(OH)D may lead to hypocalcemia, hyperparathyroidism, and diminished bone mineral density/content. Vitamin D deficiency has also been associated with multiple systemic effects including elevated blood pressure ,metabolic syndrome, cardiovascular disease ,anemia and impaired immune system regulation .

1 of 22
Download to read offline
Nephrotic syndrom and
vitamins
Ahmad Ali
Nikibakhsh Pediatric
Nephrologist
Urmia University of
Medical Sciences
Abnormal vitamin D metabolism in
idiopathic NS is multi-factorial
 losses of both vitamin D binding protein and 25(OH)D in the
urine
 The urinary losses of vitamin D binding protein may be
secondary to proteinuria.
 Deficiency in 25(OH)D may lead to hypocalcemia,
hyperparathyroidism, and diminished bone mineral
density/content.
 Vitamin D deficiency has also been associated with multiple
systemic effects including elevated blood pressure ,metabolic
syndrome, cardiovascular disease ,anemia and impaired
immune system regulation .
 Roos BA. Urinary and plasma vitamin D3 metabolites in the nephrotic syndrome. Metab
Bone Dis Relat Res. 1982;4:7–15.
25(OH)D levels25(OH)D levels
 There has been an increasing amount of data suggesting
that 25(OH)D levels may not completely normalize when
children go into remission
 Data suggest that abnormalities in 25(OH)D levels persist
and occur at a greater frequency than would be expected in
the general population.
 Banerjee S, Basu S, Sengupta J. Vitamin D in nephrotic
syndrome remission: a case–control study. Pediatr Nephrol.
2013;28
Study by
Nikibakhsh.Ahmadali,
Mahmoodzadeh.Hashem,Valizade
h.Mohammad
Effect of supplementary
use of Vitamin D on
serum level of vitamin D3
in patients with nephrotic
syndrome receiving
steroid therapy
Study by
Nikibakhsh.Ahmadali,
Mahmoodzadeh.Hashem,Valizade
h.Mohammad
 Out of 30 children 60% were male and 40% were female with
mean age of 6.91 + 3.34 years.
 Before intervention 70% of patients had sever deficiency,
26.7% mild to moderate deficiency.
 Mean level of 25(OH) D was 8.277±0.84 ng/ml rising to
14.364±1.14 ng/ml after two months that was statistically
significant (P=0.001).
Study by
Nikibakhsh.Ahmadali,
Mahmoodzadeh.Hashem,Valizade
h.Mohammad
Severe deficiency;
 The serum level of 25-hydroxy vitamin-D3 less than 10 ng/ml
Mild to moderate ;
 Patients with the levels between 10 and 20 ng/ml
Insufficient
 those with the levels between 20 and 30 ng/ml
Normal ;
 serum levels of more than 30 ng/ml

Recommended

vitamins in chronic kidney disease and hemodialysis patients
 vitamins in chronic kidney disease and hemodialysis patients vitamins in chronic kidney disease and hemodialysis patients
vitamins in chronic kidney disease and hemodialysis patientsPediatric Nephrology
 
Vitamins and urinary tract infections original
Vitamins and urinary tract infections originalVitamins and urinary tract infections original
Vitamins and urinary tract infections originalPediatric Nephrology
 
KidneyVite by MyGen Labs, Inc.
KidneyVite by MyGen Labs, Inc. KidneyVite by MyGen Labs, Inc.
KidneyVite by MyGen Labs, Inc. Giulia Agabitini
 
NIH Presentation Nutritional Counseling and Dietetics Practice in Sickle Cell...
NIH Presentation Nutritional Counseling and Dietetics Practice in Sickle Cell...NIH Presentation Nutritional Counseling and Dietetics Practice in Sickle Cell...
NIH Presentation Nutritional Counseling and Dietetics Practice in Sickle Cell...jeananno
 

More Related Content

What's hot

ANEMIA IN DIABETES MELLITUS
ANEMIA IN DIABETES MELLITUSANEMIA IN DIABETES MELLITUS
ANEMIA IN DIABETES MELLITUSNaveen Kumar
 
PTH - Chronic Renal Failure
PTH - Chronic Renal FailurePTH - Chronic Renal Failure
PTH - Chronic Renal FailureAndre Garcia
 
Role of vitamin c and thiamine in sepsis
Role of vitamin c and thiamine in sepsisRole of vitamin c and thiamine in sepsis
Role of vitamin c and thiamine in sepsisAnkit Gajjar
 
Anaemia dr. rajkumar ppt
Anaemia    dr. rajkumar pptAnaemia    dr. rajkumar ppt
Anaemia dr. rajkumar pptmadurai
 
Management of coronary disease in diabetes - Is it different?
Management of coronary disease in diabetes - Is it different?Management of coronary disease in diabetes - Is it different?
Management of coronary disease in diabetes - Is it different?Dr Vivek Baliga
 
Calcification inhibitors in ckd and dialysis patients
Calcification inhibitors in ckd and dialysis patientsCalcification inhibitors in ckd and dialysis patients
Calcification inhibitors in ckd and dialysis patientsWaleed El-Refaey
 
Anemia in pregnancy rns
Anemia in pregnancy  rnsAnemia in pregnancy  rns
Anemia in pregnancy rnsRabi Satpathy
 
Anemia in pregnancy
Anemia in pregnancyAnemia in pregnancy
Anemia in pregnancylimgengyan
 
ANEMIA IN PREGNANCY BY DR SHASHWAT JANI
ANEMIA IN PREGNANCY BY DR SHASHWAT JANIANEMIA IN PREGNANCY BY DR SHASHWAT JANI
ANEMIA IN PREGNANCY BY DR SHASHWAT JANIDR SHASHWAT JANI
 
CDK case study pdf nov 13
CDK case study pdf nov 13CDK case study pdf nov 13
CDK case study pdf nov 13Carolina chaves
 
Resistant Anemia in CKD Patients
Resistant Anemia in CKD PatientsResistant Anemia in CKD Patients
Resistant Anemia in CKD Patientsdrwaleedelrefaey
 
Darbepoetin scientific information and comparison
Darbepoetin scientific information and comparisonDarbepoetin scientific information and comparison
Darbepoetin scientific information and comparisonHarsh shaH
 

What's hot (20)

ANEMIA IN DIABETES MELLITUS
ANEMIA IN DIABETES MELLITUSANEMIA IN DIABETES MELLITUS
ANEMIA IN DIABETES MELLITUS
 
PTH - Chronic Renal Failure
PTH - Chronic Renal FailurePTH - Chronic Renal Failure
PTH - Chronic Renal Failure
 
Role of vitamin c and thiamine in sepsis
Role of vitamin c and thiamine in sepsisRole of vitamin c and thiamine in sepsis
Role of vitamin c and thiamine in sepsis
 
Nutritional anemia
Nutritional anemiaNutritional anemia
Nutritional anemia
 
Anaemia dr. rajkumar ppt
Anaemia    dr. rajkumar pptAnaemia    dr. rajkumar ppt
Anaemia dr. rajkumar ppt
 
Management of coronary disease in diabetes - Is it different?
Management of coronary disease in diabetes - Is it different?Management of coronary disease in diabetes - Is it different?
Management of coronary disease in diabetes - Is it different?
 
Zinc presentation (1)
Zinc presentation (1)Zinc presentation (1)
Zinc presentation (1)
 
Vasculopathy and ckd
Vasculopathy and ckdVasculopathy and ckd
Vasculopathy and ckd
 
Calcification inhibitors in ckd and dialysis patients
Calcification inhibitors in ckd and dialysis patientsCalcification inhibitors in ckd and dialysis patients
Calcification inhibitors in ckd and dialysis patients
 
Anemia in pregnancy rns
Anemia in pregnancy  rnsAnemia in pregnancy  rns
Anemia in pregnancy rns
 
Anemia in pregnancy
Anemia in pregnancyAnemia in pregnancy
Anemia in pregnancy
 
ANEMIA IN PREGNANCY BY DR SHASHWAT JANI
ANEMIA IN PREGNANCY BY DR SHASHWAT JANIANEMIA IN PREGNANCY BY DR SHASHWAT JANI
ANEMIA IN PREGNANCY BY DR SHASHWAT JANI
 
Beri beri
Beri beriBeri beri
Beri beri
 
CDK case study pdf nov 13
CDK case study pdf nov 13CDK case study pdf nov 13
CDK case study pdf nov 13
 
Resistant Anemia in CKD Patients
Resistant Anemia in CKD PatientsResistant Anemia in CKD Patients
Resistant Anemia in CKD Patients
 
Darbepoetin scientific information and comparison
Darbepoetin scientific information and comparisonDarbepoetin scientific information and comparison
Darbepoetin scientific information and comparison
 
Anaemia for b sc nursing
Anaemia for b sc nursingAnaemia for b sc nursing
Anaemia for b sc nursing
 
Anemia el-menyia
Anemia el-menyiaAnemia el-menyia
Anemia el-menyia
 
Anemia wi
Anemia wiAnemia wi
Anemia wi
 
Protecting the Kidney in Diabetes
Protecting the Kidney in DiabetesProtecting the Kidney in Diabetes
Protecting the Kidney in Diabetes
 

Similar to Nephrotic syndrom and vitamins

Vitamin D And Chronic Periodontitis – A Randomised Double Blinded Placebo Con...
Vitamin D And Chronic Periodontitis – A Randomised Double Blinded Placebo Con...Vitamin D And Chronic Periodontitis – A Randomised Double Blinded Placebo Con...
Vitamin D And Chronic Periodontitis – A Randomised Double Blinded Placebo Con...inventionjournals
 
Vitamin D And Chronic Periodontitis – A Randomised Double Blinded Placebo Con...
Vitamin D And Chronic Periodontitis – A Randomised Double Blinded Placebo Con...Vitamin D And Chronic Periodontitis – A Randomised Double Blinded Placebo Con...
Vitamin D And Chronic Periodontitis – A Randomised Double Blinded Placebo Con...inventionjournals
 
Diabetic Retinopathy and Vitamin D
Diabetic Retinopathy and Vitamin DDiabetic Retinopathy and Vitamin D
Diabetic Retinopathy and Vitamin DVineet Mishra
 
Nutritional Poster Presentation
Nutritional Poster PresentationNutritional Poster Presentation
Nutritional Poster PresentationMolly Carroll
 
1081220-需要補充維生素D嗎?
1081220-需要補充維生素D嗎? 1081220-需要補充維生素D嗎?
1081220-需要補充維生素D嗎? Ks doctor
 
Vitamin d and neurological diseases
Vitamin  d and neurological diseasesVitamin  d and neurological diseases
Vitamin d and neurological diseasesNeurologyKota
 
Vitamina D ed Asma - Prof. Boner Attilio Università di Verona
Vitamina D ed Asma - Prof. Boner Attilio Università di VeronaVitamina D ed Asma - Prof. Boner Attilio Università di Verona
Vitamina D ed Asma - Prof. Boner Attilio Università di VeronaRoberto Conte
 
Vitamin D and Cardiovascular Disease Where do we stand in 2017 ?
Vitamin D and Cardiovascular Disease Where do we stand in 2017 ?Vitamin D and Cardiovascular Disease Where do we stand in 2017 ?
Vitamin D and Cardiovascular Disease Where do we stand in 2017 ?magdy elmasry
 
Vitamin D in Chronic Kidney Disease
Vitamin D in Chronic Kidney DiseaseVitamin D in Chronic Kidney Disease
Vitamin D in Chronic Kidney Diseaseijtsrd
 
Vitamin d-deficiency
Vitamin d-deficiencyVitamin d-deficiency
Vitamin d-deficiencydressam72
 
Vitamin d and heart disease
Vitamin d and heart diseaseVitamin d and heart disease
Vitamin d and heart diseaseBhargav Kiran
 
Vit d and cv risks
Vit d and cv risksVit d and cv risks
Vit d and cv risksdibufolio
 
Asthma, allergy and respiratory infections: the vitamin D hypothesis
Asthma, allergy and respiratory infections: the vitamin D hypothesisAsthma, allergy and respiratory infections: the vitamin D hypothesis
Asthma, allergy and respiratory infections: the vitamin D hypothesisAriyanto Harsono
 

Similar to Nephrotic syndrom and vitamins (20)

Vitamin D And Chronic Periodontitis – A Randomised Double Blinded Placebo Con...
Vitamin D And Chronic Periodontitis – A Randomised Double Blinded Placebo Con...Vitamin D And Chronic Periodontitis – A Randomised Double Blinded Placebo Con...
Vitamin D And Chronic Periodontitis – A Randomised Double Blinded Placebo Con...
 
Vitamin D And Chronic Periodontitis – A Randomised Double Blinded Placebo Con...
Vitamin D And Chronic Periodontitis – A Randomised Double Blinded Placebo Con...Vitamin D And Chronic Periodontitis – A Randomised Double Blinded Placebo Con...
Vitamin D And Chronic Periodontitis – A Randomised Double Blinded Placebo Con...
 
Diabetic Retinopathy and Vitamin D
Diabetic Retinopathy and Vitamin DDiabetic Retinopathy and Vitamin D
Diabetic Retinopathy and Vitamin D
 
Shafei vit.d
Shafei vit.dShafei vit.d
Shafei vit.d
 
Nutritional Poster Presentation
Nutritional Poster PresentationNutritional Poster Presentation
Nutritional Poster Presentation
 
1081220-需要補充維生素D嗎?
1081220-需要補充維生素D嗎? 1081220-需要補充維生素D嗎?
1081220-需要補充維生素D嗎?
 
Vitamin D and heart disease
Vitamin D and heart diseaseVitamin D and heart disease
Vitamin D and heart disease
 
Vitamin d and neurological diseases
Vitamin  d and neurological diseasesVitamin  d and neurological diseases
Vitamin d and neurological diseases
 
CapstonePosterProject
CapstonePosterProjectCapstonePosterProject
CapstonePosterProject
 
Vitamina D ed Asma - Prof. Boner Attilio Università di Verona
Vitamina D ed Asma - Prof. Boner Attilio Università di VeronaVitamina D ed Asma - Prof. Boner Attilio Università di Verona
Vitamina D ed Asma - Prof. Boner Attilio Università di Verona
 
Vitamin D and Cardiovascular Disease Where do we stand in 2017 ?
Vitamin D and Cardiovascular Disease Where do we stand in 2017 ?Vitamin D and Cardiovascular Disease Where do we stand in 2017 ?
Vitamin D and Cardiovascular Disease Where do we stand in 2017 ?
 
Vitamin D in Chronic Kidney Disease
Vitamin D in Chronic Kidney DiseaseVitamin D in Chronic Kidney Disease
Vitamin D in Chronic Kidney Disease
 
Vitamin d-deficiency
Vitamin d-deficiencyVitamin d-deficiency
Vitamin d-deficiency
 
Vit d
Vit dVit d
Vit d
 
Vitamin d and heart disease
Vitamin d and heart diseaseVitamin d and heart disease
Vitamin d and heart disease
 
Aya
AyaAya
Aya
 
Vitamin d up to date
Vitamin d up to dateVitamin d up to date
Vitamin d up to date
 
VitDIMAshort
VitDIMAshortVitDIMAshort
VitDIMAshort
 
Vit d and cv risks
Vit d and cv risksVit d and cv risks
Vit d and cv risks
 
Asthma, allergy and respiratory infections: the vitamin D hypothesis
Asthma, allergy and respiratory infections: the vitamin D hypothesisAsthma, allergy and respiratory infections: the vitamin D hypothesis
Asthma, allergy and respiratory infections: the vitamin D hypothesis
 

More from Pediatric Nephrology

kidney transplantation in children
kidney transplantation in childrenkidney transplantation in children
kidney transplantation in childrenPediatric Nephrology
 
complication of peritoneal dialysis
complication of peritoneal dialysiscomplication of peritoneal dialysis
complication of peritoneal dialysisPediatric Nephrology
 
treament of renal stone with children
treament of  renal stone with childrentreament of  renal stone with children
treament of renal stone with childrenPediatric Nephrology
 
risk factors of urolithiasis in children
risk factors of urolithiasis in childrenrisk factors of urolithiasis in children
risk factors of urolithiasis in childrenPediatric Nephrology
 
clinical approach to renal stone in pedaitrics
clinical approach to renal stone in pedaitricsclinical approach to renal stone in pedaitrics
clinical approach to renal stone in pedaitricsPediatric Nephrology
 
renal involvement in children with covid19
renal involvement in children with covid19renal involvement in children with covid19
renal involvement in children with covid19Pediatric Nephrology
 
steroid resistant nephrotic syndrome
steroid resistant nephrotic syndromesteroid resistant nephrotic syndrome
steroid resistant nephrotic syndromePediatric Nephrology
 

More from Pediatric Nephrology (20)

Antirejection medication
Antirejection medication Antirejection medication
Antirejection medication
 
kidney transplantation in children
kidney transplantation in childrenkidney transplantation in children
kidney transplantation in children
 
hyponatremia
hyponatremiahyponatremia
hyponatremia
 
hypernatremia management
hypernatremia managementhypernatremia management
hypernatremia management
 
K balance
K balance K balance
K balance
 
Growth and nutrition in CKD child
Growth and nutrition in CKD childGrowth and nutrition in CKD child
Growth and nutrition in CKD child
 
Renal osteodystrophy
Renal osteodystrophyRenal osteodystrophy
Renal osteodystrophy
 
Anemia in CKD
Anemia in CKDAnemia in CKD
Anemia in CKD
 
probiotics in kidney disease
probiotics  in kidney diseaseprobiotics  in kidney disease
probiotics in kidney disease
 
complication of peritoneal dialysis
complication of peritoneal dialysiscomplication of peritoneal dialysis
complication of peritoneal dialysis
 
peritoneal dialysis in children
peritoneal dialysis in childrenperitoneal dialysis in children
peritoneal dialysis in children
 
immunization in renal disease
immunization in renal diseaseimmunization in renal disease
immunization in renal disease
 
kidney and the eye
kidney and the eyekidney and the eye
kidney and the eye
 
Prevention of urine stone
Prevention of  urine stonePrevention of  urine stone
Prevention of urine stone
 
treament of renal stone with children
treament of  renal stone with childrentreament of  renal stone with children
treament of renal stone with children
 
risk factors of urolithiasis in children
risk factors of urolithiasis in childrenrisk factors of urolithiasis in children
risk factors of urolithiasis in children
 
clinical approach to renal stone in pedaitrics
clinical approach to renal stone in pedaitricsclinical approach to renal stone in pedaitrics
clinical approach to renal stone in pedaitrics
 
renal involvement in children with covid19
renal involvement in children with covid19renal involvement in children with covid19
renal involvement in children with covid19
 
steroid resistant nephrotic syndrome
steroid resistant nephrotic syndromesteroid resistant nephrotic syndrome
steroid resistant nephrotic syndrome
 
Hematuria
HematuriaHematuria
Hematuria
 

Recently uploaded

New Features in the Odoo 17 Sales Module
New Features in  the Odoo 17 Sales ModuleNew Features in  the Odoo 17 Sales Module
New Features in the Odoo 17 Sales ModuleCeline George
 
Digital Footprints to Career Pathways - Building a Strong Professional Online...
Digital Footprints to Career Pathways - Building a Strong Professional Online...Digital Footprints to Career Pathways - Building a Strong Professional Online...
Digital Footprints to Career Pathways - Building a Strong Professional Online...Sue Beckingham
 
11 CI SINIF SINAQLARI - 2-2023-Aynura-Hamidova.pdf
11 CI SINIF SINAQLARI - 2-2023-Aynura-Hamidova.pdf11 CI SINIF SINAQLARI - 2-2023-Aynura-Hamidova.pdf
11 CI SINIF SINAQLARI - 2-2023-Aynura-Hamidova.pdfAynouraHamidova
 
Odontogenesis and its related anomiles.pptx
Odontogenesis and its related anomiles.pptxOdontogenesis and its related anomiles.pptx
Odontogenesis and its related anomiles.pptxMennat Allah Alkaram
 
GIÁO ÁN TIẾNG ANH GLOBAL SUCCESS LỚP 11 (CẢ NĂM) THEO CÔNG VĂN 5512 (2 CỘT) N...
GIÁO ÁN TIẾNG ANH GLOBAL SUCCESS LỚP 11 (CẢ NĂM) THEO CÔNG VĂN 5512 (2 CỘT) N...GIÁO ÁN TIẾNG ANH GLOBAL SUCCESS LỚP 11 (CẢ NĂM) THEO CÔNG VĂN 5512 (2 CỘT) N...
GIÁO ÁN TIẾNG ANH GLOBAL SUCCESS LỚP 11 (CẢ NĂM) THEO CÔNG VĂN 5512 (2 CỘT) N...Nguyen Thanh Tu Collection
 
Andreas Schleicher - 20 Feb 2024 - How pop music, podcasts, and Tik Tok are i...
Andreas Schleicher - 20 Feb 2024 - How pop music, podcasts, and Tik Tok are i...Andreas Schleicher - 20 Feb 2024 - How pop music, podcasts, and Tik Tok are i...
Andreas Schleicher - 20 Feb 2024 - How pop music, podcasts, and Tik Tok are i...EduSkills OECD
 
ICSE English Literature Class X Handwritten Notes
ICSE English Literature Class X Handwritten NotesICSE English Literature Class X Handwritten Notes
ICSE English Literature Class X Handwritten NotesGauri S
 
Nzinga Kika - The story of the queen
Nzinga Kika    -  The story of the queenNzinga Kika    -  The story of the queen
Nzinga Kika - The story of the queenDeanAmory1
 
VPEC BROUCHER FOR ALL COURSES UPDATED FEB 2024
VPEC BROUCHER FOR ALL COURSES UPDATED FEB 2024VPEC BROUCHER FOR ALL COURSES UPDATED FEB 2024
VPEC BROUCHER FOR ALL COURSES UPDATED FEB 2024avesmalik2
 
A LABORATORY MANUAL FOR ORGANIC CHEMISTRY.pdf
A LABORATORY MANUAL FOR ORGANIC CHEMISTRY.pdfA LABORATORY MANUAL FOR ORGANIC CHEMISTRY.pdf
A LABORATORY MANUAL FOR ORGANIC CHEMISTRY.pdfDr.M.Geethavani
 
SOCIAL JUSTICE LESSON ON CATCH UP FRIDAY
SOCIAL JUSTICE LESSON ON CATCH UP FRIDAYSOCIAL JUSTICE LESSON ON CATCH UP FRIDAY
SOCIAL JUSTICE LESSON ON CATCH UP FRIDAYGloriaRamos83
 
DISCOURSE: TEXT AS CONNECTED DISCOURSE
DISCOURSE:   TEXT AS CONNECTED DISCOURSEDISCOURSE:   TEXT AS CONNECTED DISCOURSE
DISCOURSE: TEXT AS CONNECTED DISCOURSEMYDA ANGELICA SUAN
 
BEZA or Bangladesh Economic Zone Authority recruitment exam question solution...
BEZA or Bangladesh Economic Zone Authority recruitment exam question solution...BEZA or Bangladesh Economic Zone Authority recruitment exam question solution...
BEZA or Bangladesh Economic Zone Authority recruitment exam question solution...MohonDas
 
Practical Research 1, Lesson 5: DESIGNING A RESEARCH PROJECT RELATED TO DAILY...
Practical Research 1, Lesson 5: DESIGNING A RESEARCH PROJECT RELATED TO DAILY...Practical Research 1, Lesson 5: DESIGNING A RESEARCH PROJECT RELATED TO DAILY...
Practical Research 1, Lesson 5: DESIGNING A RESEARCH PROJECT RELATED TO DAILY...Katherine Villaluna
 
Creative, Technical, and Academic Writing
Creative, Technical, and Academic WritingCreative, Technical, and Academic Writing
Creative, Technical, and Academic WritingMYDA ANGELICA SUAN
 
skeletal system complete details with joints and its types
skeletal system complete details with joints and its typesskeletal system complete details with joints and its types
skeletal system complete details with joints and its typesMinaxi patil. CATALLYST
 
Barrow Motor Ability Test - TEST, MEASUREMENT AND EVALUATION IN PHYSICAL EDUC...
Barrow Motor Ability Test - TEST, MEASUREMENT AND EVALUATION IN PHYSICAL EDUC...Barrow Motor Ability Test - TEST, MEASUREMENT AND EVALUATION IN PHYSICAL EDUC...
Barrow Motor Ability Test - TEST, MEASUREMENT AND EVALUATION IN PHYSICAL EDUC...Rabiya Husain
 
Data Modeling - Entity Relationship Diagrams-1.pdf
Data Modeling - Entity Relationship Diagrams-1.pdfData Modeling - Entity Relationship Diagrams-1.pdf
Data Modeling - Entity Relationship Diagrams-1.pdfChristalin Nelson
 

Recently uploaded (20)

Lipids as Biopolymer
Lipids as Biopolymer Lipids as Biopolymer
Lipids as Biopolymer
 
New Features in the Odoo 17 Sales Module
New Features in  the Odoo 17 Sales ModuleNew Features in  the Odoo 17 Sales Module
New Features in the Odoo 17 Sales Module
 
Digital Footprints to Career Pathways - Building a Strong Professional Online...
Digital Footprints to Career Pathways - Building a Strong Professional Online...Digital Footprints to Career Pathways - Building a Strong Professional Online...
Digital Footprints to Career Pathways - Building a Strong Professional Online...
 
11 CI SINIF SINAQLARI - 2-2023-Aynura-Hamidova.pdf
11 CI SINIF SINAQLARI - 2-2023-Aynura-Hamidova.pdf11 CI SINIF SINAQLARI - 2-2023-Aynura-Hamidova.pdf
11 CI SINIF SINAQLARI - 2-2023-Aynura-Hamidova.pdf
 
Odontogenesis and its related anomiles.pptx
Odontogenesis and its related anomiles.pptxOdontogenesis and its related anomiles.pptx
Odontogenesis and its related anomiles.pptx
 
GIÁO ÁN TIẾNG ANH GLOBAL SUCCESS LỚP 11 (CẢ NĂM) THEO CÔNG VĂN 5512 (2 CỘT) N...
GIÁO ÁN TIẾNG ANH GLOBAL SUCCESS LỚP 11 (CẢ NĂM) THEO CÔNG VĂN 5512 (2 CỘT) N...GIÁO ÁN TIẾNG ANH GLOBAL SUCCESS LỚP 11 (CẢ NĂM) THEO CÔNG VĂN 5512 (2 CỘT) N...
GIÁO ÁN TIẾNG ANH GLOBAL SUCCESS LỚP 11 (CẢ NĂM) THEO CÔNG VĂN 5512 (2 CỘT) N...
 
Andreas Schleicher - 20 Feb 2024 - How pop music, podcasts, and Tik Tok are i...
Andreas Schleicher - 20 Feb 2024 - How pop music, podcasts, and Tik Tok are i...Andreas Schleicher - 20 Feb 2024 - How pop music, podcasts, and Tik Tok are i...
Andreas Schleicher - 20 Feb 2024 - How pop music, podcasts, and Tik Tok are i...
 
ICSE English Literature Class X Handwritten Notes
ICSE English Literature Class X Handwritten NotesICSE English Literature Class X Handwritten Notes
ICSE English Literature Class X Handwritten Notes
 
Nzinga Kika - The story of the queen
Nzinga Kika    -  The story of the queenNzinga Kika    -  The story of the queen
Nzinga Kika - The story of the queen
 
VPEC BROUCHER FOR ALL COURSES UPDATED FEB 2024
VPEC BROUCHER FOR ALL COURSES UPDATED FEB 2024VPEC BROUCHER FOR ALL COURSES UPDATED FEB 2024
VPEC BROUCHER FOR ALL COURSES UPDATED FEB 2024
 
A LABORATORY MANUAL FOR ORGANIC CHEMISTRY.pdf
A LABORATORY MANUAL FOR ORGANIC CHEMISTRY.pdfA LABORATORY MANUAL FOR ORGANIC CHEMISTRY.pdf
A LABORATORY MANUAL FOR ORGANIC CHEMISTRY.pdf
 
SOCIAL JUSTICE LESSON ON CATCH UP FRIDAY
SOCIAL JUSTICE LESSON ON CATCH UP FRIDAYSOCIAL JUSTICE LESSON ON CATCH UP FRIDAY
SOCIAL JUSTICE LESSON ON CATCH UP FRIDAY
 
DISCOURSE: TEXT AS CONNECTED DISCOURSE
DISCOURSE:   TEXT AS CONNECTED DISCOURSEDISCOURSE:   TEXT AS CONNECTED DISCOURSE
DISCOURSE: TEXT AS CONNECTED DISCOURSE
 
BEZA or Bangladesh Economic Zone Authority recruitment exam question solution...
BEZA or Bangladesh Economic Zone Authority recruitment exam question solution...BEZA or Bangladesh Economic Zone Authority recruitment exam question solution...
BEZA or Bangladesh Economic Zone Authority recruitment exam question solution...
 
Practical Research 1, Lesson 5: DESIGNING A RESEARCH PROJECT RELATED TO DAILY...
Practical Research 1, Lesson 5: DESIGNING A RESEARCH PROJECT RELATED TO DAILY...Practical Research 1, Lesson 5: DESIGNING A RESEARCH PROJECT RELATED TO DAILY...
Practical Research 1, Lesson 5: DESIGNING A RESEARCH PROJECT RELATED TO DAILY...
 
Creative, Technical, and Academic Writing
Creative, Technical, and Academic WritingCreative, Technical, and Academic Writing
Creative, Technical, and Academic Writing
 
skeletal system complete details with joints and its types
skeletal system complete details with joints and its typesskeletal system complete details with joints and its types
skeletal system complete details with joints and its types
 
first section physiology laboratory.pptx
first section physiology laboratory.pptxfirst section physiology laboratory.pptx
first section physiology laboratory.pptx
 
Barrow Motor Ability Test - TEST, MEASUREMENT AND EVALUATION IN PHYSICAL EDUC...
Barrow Motor Ability Test - TEST, MEASUREMENT AND EVALUATION IN PHYSICAL EDUC...Barrow Motor Ability Test - TEST, MEASUREMENT AND EVALUATION IN PHYSICAL EDUC...
Barrow Motor Ability Test - TEST, MEASUREMENT AND EVALUATION IN PHYSICAL EDUC...
 
Data Modeling - Entity Relationship Diagrams-1.pdf
Data Modeling - Entity Relationship Diagrams-1.pdfData Modeling - Entity Relationship Diagrams-1.pdf
Data Modeling - Entity Relationship Diagrams-1.pdf
 

Nephrotic syndrom and vitamins

  • 1. Nephrotic syndrom and vitamins Ahmad Ali Nikibakhsh Pediatric Nephrologist Urmia University of Medical Sciences
  • 2. Abnormal vitamin D metabolism in idiopathic NS is multi-factorial  losses of both vitamin D binding protein and 25(OH)D in the urine  The urinary losses of vitamin D binding protein may be secondary to proteinuria.  Deficiency in 25(OH)D may lead to hypocalcemia, hyperparathyroidism, and diminished bone mineral density/content.  Vitamin D deficiency has also been associated with multiple systemic effects including elevated blood pressure ,metabolic syndrome, cardiovascular disease ,anemia and impaired immune system regulation .  Roos BA. Urinary and plasma vitamin D3 metabolites in the nephrotic syndrome. Metab Bone Dis Relat Res. 1982;4:7–15.
  • 3. 25(OH)D levels25(OH)D levels  There has been an increasing amount of data suggesting that 25(OH)D levels may not completely normalize when children go into remission  Data suggest that abnormalities in 25(OH)D levels persist and occur at a greater frequency than would be expected in the general population.  Banerjee S, Basu S, Sengupta J. Vitamin D in nephrotic syndrome remission: a case–control study. Pediatr Nephrol. 2013;28
  • 4. Study by Nikibakhsh.Ahmadali, Mahmoodzadeh.Hashem,Valizade h.Mohammad Effect of supplementary use of Vitamin D on serum level of vitamin D3 in patients with nephrotic syndrome receiving steroid therapy
  • 5. Study by Nikibakhsh.Ahmadali, Mahmoodzadeh.Hashem,Valizade h.Mohammad  Out of 30 children 60% were male and 40% were female with mean age of 6.91 + 3.34 years.  Before intervention 70% of patients had sever deficiency, 26.7% mild to moderate deficiency.  Mean level of 25(OH) D was 8.277±0.84 ng/ml rising to 14.364±1.14 ng/ml after two months that was statistically significant (P=0.001).
  • 6. Study by Nikibakhsh.Ahmadali, Mahmoodzadeh.Hashem,Valizade h.Mohammad Severe deficiency;  The serum level of 25-hydroxy vitamin-D3 less than 10 ng/ml Mild to moderate ;  Patients with the levels between 10 and 20 ng/ml Insufficient  those with the levels between 20 and 30 ng/ml Normal ;  serum levels of more than 30 ng/ml
  • 7.  Before intervention none of the patients had normal serum level of 25-(OH)-D and after one month, only one patient gained normal level which was not statistically significant (P=0.500).  vitamin D levels at three times (beginning, one month, and two month after intervention). According to the results of this table, it can be seen that the mean serum level of vitamin D before intervention was 8.27 ± 0.84 ng/ml, with increasing to 14.36± 1.14 and finally reaching 27.78 ±2.80 after two month of treatment.  After two months of intervention, 12 patients escaped deficiency but still insufficient followed by 8 people with deficiency and 10 reached normal values which was statistically significant (P=0.002)
  • 8. Time Baseline After 1month Treatment After2Month Treatment P value Severe Deficiency 21 (70) 5 (16.7) 1 (3.3) 0.001 Mild-Moderate Deficiency 8 (26.7) 21 (70) 7 (23.3) Insufficient 1 (3.3) 3 (10) 12 (40) Normal --- 1 (3.3) 10 (33.3) Total 30 (100) 30 (100) 30 (100)
  • 9. Study by Nikibakhsh.Ahmadali, Mahmoodzadeh.Hashem,Valizade h.Mohammad We suggest that children may benefit from routine measurement of their serum vitamin D levels at the time of diagnosis and later on fallow-up visits so an individual strategy for treatment with vitamin D can be given.
  • 10.  A daily dose of systemic steroids as low as 5 mg per day has been shown to contribute to osteoporosis in adults .  This is of concern in pediatric patients following a new diagnosis of NS where steroid treatment protocols exceed the dose at which adult osteoporosis risk increases with repeated exposures to steroids during subsequent relapses  Leonard MB, Zemel BS. Current concepts in pediatric bone disease. Pediatr Clin N Am. 2002;49:143–173.
  • 11.  Data suggest that, all children with incident NS had 25(OH)D deficiency at diagnosis and the majority continued to have a deficiency at 2–4 months.  Furthermore, supplemental vitamin D decreased the odds of 25(OH)D deficiency, suggesting the need for future interventional studies addressing vitamin D supplementation in incident NS to evaluate optimal vitamin D dosing and long-term impact in these children.  Selewski DT Vitamin D in incident nephrotic syndrome: a Midwest Pediatric Nephrology Consortium study. Pediatric Nephrology (Berlin, Germany), 22 Oct 2015, 31(3):465-472
  • 12.  Short-term, high-dose glucocorticoid therapy decreases the BMC of the lumbar spine in steroid-naïve children with NS. Vitamin D and calcium co-administration not only prevents this decline, but also enhances BMC of the lumbar spine.  The 1000 IU/day dose is marginally more effective than 400 IU/day and it is likely than an even larger dose is required.  Further research is required to assess the efficacy and safety of vitamin D doses higher than 1000 IU/day.  S Choudhary, Calcium and vitamin D for osteoprotection in children with new-onset nephrotic syndrome treated with steroids Pediatric Nephrology, 2014,
  • 13.  Vitamin D plus calcium therapy at the current doses(vitamin D 40 0 IU plus calcium 1 g daily) reduces but does not completely prevent bone loss, with no additional adverse effects  S Choudhary, Calcium and vitamin D for osteoprotection in children with new-onset nephrotic syndrome treated with steroids Pediatric Nephrology, 2014
  • 14.  Several studies indicate a relationship between hypovitaminosis D, survival, vascular calcification and inflammation.  In addition to its central role in the regulation of bone mineral metabolism, vitamin D also contributes to other systems, including the immune, cardiovascular and endocrine systems.  Vitamin D analogs reduces proteinuria, in particular through suppression of the renin-angiotensin-aldosterone system (RAAS) and exerts anti-inflammatory and immunomodulatory effects.  A Passantino, C Aloisi, V Cernaro, D Santoro New insights on the role of vitamin D in the progression of renal damage- Kidney and Blood …, 2013  …,
  • 15.  Vitamin D deficiency contribute to an inappropriately activated RAAS, as a mechanism for progression of chronic kidney disease (CKD) and/or cardiovascular disease.  Vitamin D may interact with B and T lymphocytes and influence the phenotype and function of the antigen presenting cells and dendritic cells, promoting properties that favor the induction of tolerogenic T regulators rather than T effectory.  A Passantino, C Aloisi, V Cernaro, D Santoro New insights on the role of vitamin D in the progression of renal damage- Kidney and Blood …, 2013
  • 16.  Interstitial fibrosis may be prevented through vitamin D supplementation.  It turns out that calcitriol effectively blocks myofibroblast activation from interstitial fibroblasts, as evidenced by suppression of TGF-β1-mediated α-SMA expression.  A Passantino, C Aloisi, V Cernaro, D Santoro New insights on the role of vitamin D in the progression of renal damage- Kidney and Blood …, 2013
  • 17.  previous studies confirmed that vitamin D receptors reduced proteinuria, lessened the degree of glomerular sclerosis, and exerted protective effects against kidney diseases by inhibiting the renin angiotensin system, and having an anti- inflammatory and anti-fibrotic effect.  Supplementation with 1,25-vitamin D3or1,25-vitamin D2prevented podocyte effacement or reversed glomerular and tubulointerstitial damage in1,25-vitamin D3edeficient animals, thereby preserving and restoring renal function, respectively.  Ramon Sonneveld 1,25-Vitamin D3 Deficiency Induces Albuminuria Am J Pathol 2016 Apr;
  • 18. vitamin B6  Patients with the nephrotic syndrome have multiple risk factors for thrombosis.  Some reports indicate that they frequently have low circulating levels of vitamin B6, which associate with a heightened risk for venous and arterial thrombosis.  GM Podda, F Lussana, G Moroni ,Abnormalities of homocysteine and B vitamins in the nephrotic syndrome  - Thrombosis research, 2007  .
  • 19. α-tocopherol and vitamin C,  The combination of vitamins C and E had beneficial effects in endothelial-dependent vasodilation and arterial stiffness.  Thus, combination of α-tocopherol and vitamin C can be used in the clinical management of pediatric idiopathic nephrotic syndrome.  significant reduction in first-morning urine pro- tein:creatinine ratios in 10 of the 11 children with FSGS (the mean protein:creatinine ratio decreased from 9.7 to 4.1 .  O Mellyana, R Widajat, N Sekarwana Combined supplementation with α-tocopherol and vitamin C improves the blood pressure of pediatric idiopathic nephrotic syndrome patients  - Clinical Nutrition Experimental, 2019 