Relationship between Serum 25(OH)D Levels and Blood Pressure in Children with Nephrotic Syndrome
DOI:
https://doi.org/10.3889/oamjms.2021.5672Keywords:
Nephrotic syndrome, Serum vitamin D levels, Blood pressureAbstract
BACKGROUND: Vitamin D plays an eminent role in the renin-angiotensin system that may interfere with blood pressure regulation. Children with nephrotic syndrome (NS) are often observed with low serum vitamin D levels that may lead to Vitamin D deficiency status.
AIM: This study aimed to investigate the correlation between serum vitamin D [25(OH)D] levels and blood pressure in children with NS.
METHODS: A cross-sectional, observational analytic study was conducted in 35 children NS with minimal change diseases from February to August 2019 in Haji Adam Malik General Hospital, Medan. Blood pressure was examined and serum Vitamin D levels along with serum creatinine, albumin, and calcium were measured.
RESULTS: Of 35 children, 21 children (60%) had proteinuria. Regarding the category of Vitamin D status, there were 40% and 34.3% with deficiency and severe deficiency of Vitamin D, respectively. The median serum Vitamin D levels were not significantly different among the age group. Children with proteinuria showed lower serum Vitamin D levels (P < 0.001). There was an elevation of systolic and diastolic blood pressure in children with proteinuria (P = 0.039 and P = 0.036, respectively). Our study showed a weak negative correlation between serum Vitamin D levels and either systolic or diastolic blood pressure (r-0.114 and r-0.174, respectively).
CONCLUSION: Both Vitamin D deficiency and severe deficiency are common in children with NS. In this study, serum Vitamin D levels have been shown to have a weak negative correlation with blood pressure in children with NS.
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Park SJ, Shin JI. Complication of nephrotic syndrome. Korean J Pediatr. 2011;54(8):322-8. PMid:22087198 DOI: https://doi.org/10.3345/kjp.2011.54.8.322
Eddy AA, Symons JM. Nephrotic syndrome in childhood. Lancet.2003;362(9384):629-39. https://doi.org/10.1016/s0140-6736(03)14184-0 PMid:12944064 DOI: https://doi.org/10.1016/S0140-6736(03)14184-0
Wila WIGN. Penelitian Beberapa Aspek Klinis dan Patologi Anatomis Sindrom Nefrotik Primer Pada Anak di Indonesia. Jakarta: Disertasi, FKUI; 1992. https://doi.org/10.14238/sp15.3.2013.133-6 DOI: https://doi.org/10.14238/sp15.3.2013.133-6
DeLuca HF, Sempos CT, Heijboer AC, Bikle DD, Bollerslev J, Bouillon R, et al. Vitamin D assays and the definition of hypovitaminosis D: Results from the First International Conference on Controversies in Vitamin D. Br J Clin Pharmacol. 2018;84(10):2194-207. https://doi.org/10.1111/bcp.13652 PMid:29851137 DOI: https://doi.org/10.1111/bcp.13652
Poh BK, Rojroongwasinkul N, Nguyen BK, Sandjaja, Ruzita AT, Yamborisut U, et al. 25-hydroxy-vitamin D demography and the risk of Vitamin D insuffiency in the South East Asian Nutrition Surveys (SEANUTS). Asia Pac Clin Nutr 2016;25(3):538-48. PMid:27440689
Nielsen CA, Jensen JE, Cortes D. Vitamin D status is insufficient in the majority at diagnosis of nephrotic syndrome. Dan Med J. 2015;62(2):A5017. PMid:25634505
Fanari Z, Hamami S, Hammami MB, Hammami S, Abdellatif A. Vitamin D deficiency plays an important role in cardiac disease and affects patient outcome: Still a myth or a fact that needs exploration? J Saudi Heart Assoc. 2015;27(4):264-71. https://doi.org/10.1016/j.jsha.2015.02.003 PMid:26557744 DOI: https://doi.org/10.1016/j.jsha.2015.02.003
Yuan W, Pan W, Kong K, Zheng W, Szeto FL, Wong KE, et al. 1.25 dihydroxyvitamin D3 suppressesrenin gene transcription by blocking the activity of the cyclic AMP response element in the renin gene promoter. J Biol Chem. 2007;282(41):29821-30. https://doi.org/10.1074/jbc.m705495200 PMid:17690094 DOI: https://doi.org/10.1074/jbc.M705495200
National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents. The 4th Report on the Diagnosis, Evaluation, and Treatment of High Blood Pressure in Children and Adolescents, NIH; 2005. https://doi.org/10.1542/peds.114.2.s2.555 DOI: https://doi.org/10.1542/peds.114.2.S2.555
Li Y, Kong J, Wei M, Chen ZF, Liu SQ, Cao LP. 1,25Dihydroxyvitamin D3 is a negative endocrine regulator of the renin-angiotensin system. J Clin Invest. 2002;110(2):229-38. https://doi.org/10.1172/jci0215219 PMid:12122115 DOI: https://doi.org/10.1172/JCI0215219
Forman JP, Williams JS, Fisher ND. Plasma 25-hydroxyvitamin D and regulation of the renin-angiotensin system in humans. Hypertension. 2010;55(5):1283-8. https://doi.org/10.1161/hypertensionaha.109.148619 PMid:20351344 DOI: https://doi.org/10.1161/HYPERTENSIONAHA.109.148619
Jeong HY, Park KM, Lee MJ, Yang DH, Kim SH, Lee SY. Vitamin D and hypertension. Electrolyte Blood Press. 2017;15(1):1-11. PMid:29042901 DOI: https://doi.org/10.5049/EBP.2017.15.1.1
Andrukhova O, Slavic S, Zeitz U, Riesen SC, Heppelmann MS, Ambrisko TD, et al. Vitamin D is a regulator of endothelial nitric oxide synthase and arterial stiffness in mice. Mol Endocrinol. 2014;28(1):53-64. https://doi.org/10.1210/me.2013-1252 PMid:24284821 DOI: https://doi.org/10.1210/me.2013-1252
Shi H, Norman AW, Okamura WH, Sen A, Zernel MB. 1 alpha,5 dyhydrovitamin D3 modulates human adipocyte metabolism via non-genomic action. FASEB J. 2001;(14):2751-3. https://doi.org/10.1096/fj.01-0584fje PMid:11606486 DOI: https://doi.org/10.1096/fj.01-0584fje
Solanski JR, Shruthy S, Kalpita SS. Prevalence of Vitamin D3 deficiency among pediatric patient with idiophaticnephrotic syndrome in remission a cross sectional observational study from Vododara, Gujarat. Indian J Child Health. 2018;5(7):481-3. https://doi.org/10.32677/ijch.2018.v05.i07.007 DOI: https://doi.org/10.32677/IJCH.2018.v05.i07.007
Illalu S, Velagala SV, Sudhindrashayana R. Study of prevalence of Vitamin D deficiency in nephrotic syndrome. Int J Contemp Pediatr. 2019;6(2):288-94. https://doi.org/10.18203 / 2349-3291.ijcp20190502 DOI: https://doi.org/10.18203/2349-3291.ijcp20190502
Schmidt-Gayk H, Grawunder C, Tschope W, Schmitt W, Ritz E, Pietsch V. 25-hydroxy-Vitamin-D in nephrotic syndrome. Lancet. 1977;2(8029):105-8. https://doi.org/10.1016/s0140-6736(77)90118-0 PMid:69193 DOI: https://doi.org/10.1016/S0140-6736(77)90118-0
Goldstein DA, Haldiman B, Sherman D, Norman AW, Massry SG. Vitamin D metabolite and calcium metabolism in patients with nephrotic syndrome and normal renal function. J Endocrinol Metabol. 1981;52(1):116-22. https://doi.org/10.1210/jcem-52-1-116 PMid:6969729 DOI: https://doi.org/10.1210/jcem-52-1-116
Doorenbos CR, Milton M, Vogt L, Kema IP, van den Born J, Gans RO, et al. Antiproteinuric treatment reduces urinary loss of Vitamin D-binding protein but does not affect Vitamin D status in patients with chronic kidney disease. J Steroid Biochem Mol Biol. 2012;128(1-2):56-61. https://doi.org/10.1016/j.jsbmb.2011.09.002 PMid:21958677 DOI: https://doi.org/10.1016/j.jsbmb.2011.09.002
Szeto CC, Chow KM, Kwan BC, Chung KY, Leung CB, Li PK. Oral calcitriol for the treatment of persistent proteinuria in immunoglobulin A nephropathy: An uncontrolled trial. Am J Kidney Dis. 2008;51(5):724-31. https://doi.org/10.1053/j.ajkd.2007.12.038 PMid:18436082 DOI: https://doi.org/10.1053/j.ajkd.2007.12.038
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Copyright (c) 2020 Rosmayanti Syafriani Siregar, Oke Rina Ramayani (Author); Winson Chitra, Rafita Ramayati
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