The Therapeutic Efficacy Of Different Doses Of Vitamin D Combined With Calcium For Children With Nephrotic Syndrome

Objective:To study the therapeutic efficacy and safety of two different doses of vitamin D₃?1400IU/day vs.1000IU/day?combined with calcium for children with nephrotic syndrome,so to provide theoretical evidence for vitamin D supplementation in children with nephrotic syndrome.Methods:64 children with new-onset nephrotic syndrome?n=12?and IFRNS?n=52?who were admitted into the affiliated hospital of Southwest Medical University from January 2018 to June 2019 were randomly selected and equally divided into groups A and B?children with IFRNS in groups A and B were divided into groups A₁ and B₁,and children with new-onset nephrotic syndrome were divided into groups A₂ and B₂;children with no infection in groups A and B were divided into groups A₃ and B₃?.In group A,32 children were treated with vitamin D₃ 1400IU/day combined with calcium 500mg/day on the basis of glucocorticoid therapy and other medicines.In group B,32children were treated with vitamin D₃ 1000IU/day combined with calcium500mg/day and the same therapy as group A.Respectively,before the treatment,one month after treatment,three months after treatment,the levels of serum25-hydroxyvitamin D[25-?OH?D],serum calcium and parathyroid hormone?PTH?were detected,and the proportionate changes of 25-?OH?D,serum calcium and PTH were compared.Ruled out the cases with infection during the study,the levels of plasma albumin?ALB?and 24-hour urinary protein quantity?24HUP?were detected and compared before and after treatment.The side effects and the rates of infection in the period of treatment were compared in groups A and B.Results:?1?Before treatment,there were no significant difference of gender,age at enrolment,age at onset of nephrotic syndrome,course of nephrotic syndrome,weight,height,BMI,clinical type and recurrence rate in groups A and B?P>0.05?.And the laboratory test index including 25-?OH?D,serum calcium and PTH before treatment had no significant difference?P>0.05?.?2?The increase rates of 25-?OH?D in group A after one month and three months treatment were higher than group B in the same time period?P<0.05?,the proportionate changes of serum calcium and PTH in the same time period in groups A and B had no significantly different?P>0.05?.?3?Before treatment,there were no significant difference of gender,age at enrolment,age at onset of nephrotic syndrome,course of nephrotic syndrome,weight,height,BMI,clinical phenotype and recurrence rate in children with IFRNS in groups A₁ and B₁?P>0.05?.The value of 25-?OH?D,serum calcium and PTH before treatment had no significant difference?P>0.05?.?4?The increase rates of 25-?OH?D in group A₁ after one month and three months treatment were higher than group B₁in the same time period?P<0.05?,the proportionate changes of serum calcium and PTH in the same time period of two groups had not significantly different?P>0.05?.?5?Before treatment,there were no significant difference of gender,age,weight,height,BMI in children with new-onset nephrotic syndrome in two groups of A₂ and B₂?P>0.05?.And the value of 25-?OH?D,serum calcium and PTH before treatment had no significant difference?P>0.05?.?6?The proportionate changes of 25-?OH?D,serum calcium and PTH in the same time period of two groups had no significantly different?P>0.05?.?7?Ruled out the cases with infection,after three months treatment,24HUP in groups A₃ and B₃ both decreased significantly compared with that before treatment,and ALB increased significantly?P<0.05?.The level of 24HUP in group A₃ was lower than group B₃ after three months treatment?P<0.05?.The level of ALB in group A₃ was higher than group B₃ after three months treatment?P<0.05?.?8?The rates of infection had no significantly different between group A and B?P>0.05?.?9?No adverse reaction,such as Vitamin D poisoning or hypercalcemia,were found in groups A and B.Conclusion:?1?The levels of 25-?OH?D and serum calcium decreased in almost all children with nephrotic syndrome.?2?Vitamin D₃ 1400IU/day combined with calcium 500mg/day in children with new-onset nephrotic syndrome and IFRNS is more effective than the therapeutic of vitamin D₃1000IU/day combined with calcium 500mg/day,and no adverse reactions.