Abstract
Relapses in steroid-sensitive nephrotic syndrome (SSNS) often follow infections of the respiratory or gastrointestinal tract. Based on data that zinc supplements reduce the risk of infections, we examined the efficacy of such supplements in reducing relapse rates in these patients. Eighty-one patients with SSNS (1–16 years old) were stratified into frequent (n = 52) and infrequent (n = 29) relapsers and randomized to receive 12-months of therapy with the recommended dietary allowance of zinc (10 mg/day) (n = 40) or placebo (n = 41). Patients with frequent relapses also received long-term, alternate-day prednisolone. Subjects receiving zinc showed a 20% lower frequency of relapses, with 44.7% of the patients having sustained remission compared to 27.5% in the placebo group (P > 0.05). Patients with frequent relapses receiving zinc showed a 28% reduction in relapse rates and a significantly higher likelihood of sustained remission (P = 0.02). Findings from this double blind, randomized study suggest that zinc supplementation results in trends towards remission and reduced relapses, especially in patients with frequent relapses. Prospective, adequately powered studies are required for confirmation of these findings.
References
Niaudet P (2004) Steroid sensitive idiopathic nephrotic syndrome in children. In: Avner ED, Harmon WE, Niaudet P (eds) Textbook of pediatric nephrology, 5th edn., Lippincott Williams & Wilkins, Philadelphia, pp 543–556
Mathieson PW (2003) Immune dysregulation in minimal change nephropathy. Nephrol Dial Transplant 18[Suppl 6]:vi26–29
Van Den Berg JG, Aten J, Chand MA, Claessen N, Dijkink L, Wijdenes J, Lakkis FG, Weening JJ (2000) Interleukin-4 and interleukin-13 act on glomerular visceral epithelial cells. J Am Soc Nephrol 11:413–422
Reimold EW (1980) Changes in zinc metabolism during the course of the nephrotic syndrome. Am J Dis Child 134:46–50
Tumer N, Baskan S, Arcasoy A, Cavdar AO, Ekim M (1989) Zinc metabolism in nephrotic syndrome. Nephron 52:95
Shankar AH, Prasad AS (1998) Zinc and immune function: the biological basis of altered resistance to infection. Am J Clin Nutr 68:447S–463S
Prasad AS (2007) Zinc: mechanisms of host defense. J Nutr 137:1345–1349
Aggarwal R, Sentz J, Miller MA (2007) Role of zinc administration in prevention of childhood diarrhea and respiratory illnesses: a meta-analysis. Pediatrics 119:1120–1130
Elizabeth KE (2004) Vitamins and minerals in clinical practice. In: Elizabeth KE (ed) Nutrition and child development, 3rd edn., Paras Publisher, Hyderabad, pp 93–133
Hodson EM, Knight JF, Willis NS, Craig JC (2004) Corticosteroid therapy for nephrotic syndrome in children. Cochrane Database Syst Rev 2:CD001533
Bao B, Prasad AS, Beck FW, Godmere M (2003) Zinc modulates mRNA levels of cytokines. Am J Physiol Endocrinol Metab 285:1095–1102
Szeto C, Gillespie KM, Mathieson PW (2000) Levamisole induces interleukin-18 and shifts type 1/type 2 cytokine balance. Immunology 100:217–224
Acknowledgments
The research was supported by a grant from the All India Institute of Medical Sciences, New Delhi.
Author information
Authors and Affiliations
Corresponding author
Additional information
Cochrane Renal Group Registry (CRG030600044)
Rights and permissions
About this article
Cite this article
Arun, S., Bhatnagar, S., Menon, S. et al. Efficacy of zinc supplements in reducing relapses in steroid-sensitive nephrotic syndrome. Pediatr Nephrol 24, 1583–1586 (2009). https://doi.org/10.1007/s00467-009-1170-5
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00467-009-1170-5