Vitamin D insufficiency in steroid-sensitive nephrotic syndrome in remission

Serum 25-hydroxyvitamin D [ 25( OH) D] concentrations are the best indicator of vitamin D nutritional status. We measured serum 25( OH) D concentrations in 94 healthy controls and in 41 subjects ( aged 4 - 22 years) with steroid-sensitive nephrotic syndrome (SSNS) in remission. Children with remitted SSNS had significantly lower 25( OH) D concentrations than healthy controls ( median 16.4 ng/ml versus 23.9 ng/ml, P< 0.001). In a multivariable logistic regression model, the odds ratios ( OR) of vitamin D insufficiency [ 25( OH) D < 20 ng/ml] were independently increased in SSNS subjects [ OR 11.2 ( 95% confidence interval 3.5 - 36.2)], non-whites [ OR 12.9 (4.6 - 36.2)], older children [ OR 1.20 per year (1.06 - 1.36)], and winter months [ OR 6.7 (2.5 - 18.4)]. Within the SSNS subjects, multiple linear regression determined that serum 25( OH) D concentrations were not associated with SSNS disease characteristics measured in this study, such as duration of disease, number of relapses, cumulative glucocorticoids, and interval since last relapse. In conclusion, children with remitted SSNS have lower serum 25( OH) D concentrations than healthy controls. This difference persisted after adjusting for the potential confounding effects of age, race, season, and milk intake. Children with remitted SSNS may benefit from routine measurement of 25( OH) D, but the clinical significance of low 25( OH) D in this population remains unclear.