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The clinical relevance of native vitamin D in pediatric kidney disease

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Abstract

Hypovitaminosis D has been reported to be common in chronic kidney disease (CKD) as well as in proteinuric disorders. We reviewed available evidence to assess clinically relevant effects of low vitamin D status and native vitamin D (NVD) therapy, in pediatric renal diseases. Online medical databases were searched for articles related to vitamin D status, associations of hypovitaminosis D and effects of NVD therapy in kidney disease. Hypovitaminosis D was associated with worse skeletal, cardiovascular, inflammatory, and renal survival outcomes in CKD. Low serum 25 hydroxy-vitamin D (25[OH]D) levels correlated positively with glomerular filtration rate and negatively with serum parathyroid (PTH) levels. However, to date, evidence of benefit of NVD supplementation is restricted mainly to improvements in serum PTH, and biochemical 25[OH]D targets form the basis of clinical practice recommendations for NVD therapy. In nephrotic syndrome (NS) relapse, studies indicate loss of 25[OH]D along with vitamin D binding protein in urine, and serum total 25[OH]D levels are low. Preliminary evidence indicates that free 25[OH]D may be a better guide to the biologically active fraction. NVD therapy in NS does not show consistent results in improving skeletal outcomes and hypercalciuria has been reported when total 25[OH]D levels were considered as indication for therapy. NVD formulations should be regularised, and therapy monitored adequately to avoid adverse effects.

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Authors and Affiliations

  1. Department of Pediatric Nephrology, Institute of Child Health, Kolkata, India

    Sushmita Banerjee & Jayati Sengupta

  2. Department of Biochemistry, Institute of Child Health, Kolkata, India

    Surupa Basu

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  1. Sushmita Banerjee
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Conception and outline was by S Banerjee. S Banerjee and JS focused on review of clinical evidence, and S Basu on physiology and biochemical components. All authors contributed to writing the manuscript.

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Banerjee, S., Sengupta, J. & Basu, S. The clinical relevance of native vitamin D in pediatric kidney disease. Pediatr Nephrol 38, 945–955 (2023). https://doi.org/10.1007/s00467-022-05698-9

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