The Changes Of Serum Dickkopf-1and TRACP-5b In Preschoolers With Nephritic Syndrome And The Influence Of Different Doses Of Calcium And Vitamin D₃to Them

ObjectiveTo investigate the changes of serum DKK-1(Dickkopf-1) and tartrate resistantacid phosphatase (tartrate-resistant, acidphosphatase, TRACP-5b) in children withnephrotic syndrome, and the effect of supplemented with different doses of calciumand vitamin D3on them.MethodsChoose the preschool children patients50cases from January2012to December2013in the First Affiliated Hospital of Zhengzhou University with primary nephriticsyndrome as the object of study. Male34cases, female16cases, mean age (3.19±0.98) years old. They were randomly divided into2groups. Cases in Group1weregave glucocorticoid and600mg calcium and200IU vitamin D3(n=25). Cases inGroup2were gave glucocorticoid and900mg calcium and300IU vitamin D3(n=25).20healthy preschool children as a normal control group were received no drugtreatment. Everyone in groups were detected the concentration of serum calcium,phosphorus, TRACP-5b, DKK-1and25(OH)D3. The general information in thesechildren were observed, such as urine routine, blood routine,24hours urine protein, kidney function, liver function, blood lipid levels and so on. The duration offollow-up was from the beginning of patients after diagnosed, the duration was6months. During the application of glucocorticoid therapy, there was a routineexamination of the urine weekly. Every3months the concentration of serum calcium,phosphorus, TRACP-5b, DKK-1, serum albumin (Alb) and25(OH)D3were detected.The duration was6months.Results1. In Group1and Group2: Before treatment, the DKK-1, TRACP-5b wassignificantly higher than the normal control group, the difference was statisticallysignificant (P<0.05), after3months of treatment, after treatment6months DKK-1,TRACP-5b compared with normal control group, the difference was not statisticallysignificant(P>0.05).2. In Group1and Group2: the serum DKK-1repeated measurement results showthat there is not enough evidence to infer there are differences between the twogroups. Pairwise comparison results show that: Under α=0.05/3inspection standard,DKK-1decreases with increasing treatment time, The difference was statisticallysignificant between before treatment and6months after treatment (P<α).3. In Group1and Group2: the serum TRACP-5b repeated measurement resultsshow that there is not enough evidence to infer there are differences between the twogroups. Pairwise comparison results show that: Under α=0.05/3inspection standard,TRACP-5b decreases with increasing treatment time, the difference between twoadjacent time points were statistically significant (P<α).4. Correlation analysis of50cases on serum DKK-1and TRACP-5b levels showsthat using Pearson correlation analysis, serum DKK-1level before treatment inchildren was positively correlates with24-hour urinary protein excretion (r=0.451, P=0.011<0.05), while DKK-1level and calcium, phosphorus, serum albumin,25(OH)D3was no correlation (all P>0.05). Pre-treatment of children with serum TRACP-5blevels and calcium,24-hour urine protein were positively correlated (all P <0.05),TRACP-5b levels of phosphorus, albumin,25(OH) D3was no correlation (P>0.05). Conclusion1. NS children with significantly abnormal bone metabolism who are not givencorticosteroid early treatment in the disease, has a risk of osteoporosis.2. Children with nephrotic syndrome DKK-1was significantly higher than thenormal age children. As a marker of bone formation，DKK-1can be used as anindicator on early evaluation of bone metabolism in children with nephroticsyndrome.3. TRACP-5b of children with nephrotic syndrome was significantly higherthan normal. As a second generation of bone resorption marker，TRACP-5b can beused in children with nephrotic syndrome as an indicator on early evaluation of bonemetabolism.4. Preschool children with nephrotic syndrome in600mg calcium supplementwhile200IU vitamin D supplement are safe and effective.