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Nephrocalcinosis in children who received high-dose vitamin D

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Abstract

Background

Vitamin D supplements are readily available as over-the-counter preparations. However, although rare, cases of vitamin D overdose still occur and are associated with nephrocalcinosis and life-threatening hypercalcemia. Errors in manufacturing of nutritional supplements may be a cause of vitamin D intoxication in children. This study aimed to identify factors associated with vitamin D overdose-related nephrocalcinosis in children due to manufacturing errors in supplements.

Methods

This retrospective study reviewed medical charts of pediatric patients with non-registered supplement-related vitamin D overdose at a tertiary referral hospital between 2006 and 2011. Clinical and laboratory characteristics of patients with or without nephrocalcinosis were evaluated. Receiver operating characteristics curve and area under the receiver operating characteristics curve were used to determine the most predictive value of each characteristic.

Results

A total of 44 patients (males: 29; age: 7–62 months) were included. Age ≤ 16.5 months, body weight ≤ 10.25 kg, body height ≤ 78.5 cm, body surface area (BSA) ≤ 0.475 m2, 25-hydroxyvitamin D3 ≥ 143 ng/mL, and calcium ≥ 10.65 mg/dL were predictive of developing nephrocalcinosis with a sensitivity and specificity of > 60%. Univariant analysis revealed that BSA was the most significant anthropometric prognostic factor (odds ratio: 12.09; 95% confidence interval: 2.61–55.72; P = 0.001).

Conclusions

Children with smaller BSAs were more vulnerable to high-dose vitamin D3-related nephrocalcinosis. Physicians and parents should be aware of the potential adverse effects of vitamin D overdose in children.

Graphical abstract

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Data availability

The data generated and analyzed during the current study are available from the corresponding author on reasonable request.

Code availability

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Abbreviations

AKI:

Acute kidney injury

Alk-P:

Alkaline phosphatase

AUC:

Area under receiver operating characteristics curve

BH:

Body height

BMI:

Body mass index

BSA:

Body surface area

BW:

Body weight

Ca:

Calcium

Ca/Cr:

Calcium per creatinine

CI:

Confidence interval

Cr:

Creatinine

iPTH:

Intact parathyroid hormone

IU:

International units

NC:

Nephrocalcinosis

OR:

Odds ratio

P:

Phosphate

ROC:

Receiver operating characteristics

1,25(OH)2D3 :

1,25-Dihydroxyvitamin D3

25(OH)D3 :

25-Hydroxyvitamin D

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Author information

Authors and Affiliations

  1. Department of Pediatrics, MacKay Children’s Hospital, No 92, Section 2, Chung-Shan North Road, Taipei, Taiwan

    Tzu-Hua Lin, Brian Pin-Hsuan Chang, Chun-Chen Lin & Jeng-Daw Tsai

  2. Department of Pediatrics, Hsinchu MacKay Memorial Hospital, Hsinchu, Taiwan

    Hsiang-Ju Lu, Chao-Hsu Lin & Ming-Dar Lee

  3. Department of Pediatrics, National Taiwan University Hospital, Hsin-Chu Branch, Hsinchu, Taiwan

    Hsiang-Ju Lu

  4. Department of Biological Science and Technology, National Yang Ming Chiao Tung University, Hsinchu, Taiwan

    Chao-Hsu Lin

  5. Department of Medicine, Mackay Medical College, New Taipei City, Taiwan

    Brian Pin-Hsuan Chang, Chun-Chen Lin & Jeng-Daw Tsai

  6. Mackay Junior College of Medicine, Nursing and Management, Taipei, Taiwan

    Brian Pin-Hsuan Chang & Chun-Chen Lin

  7. Graduate Institute of Health and Biotechnology Law, Taipei Medical University, Taipei, Taiwan

    Brian Pin-Hsuan Chang

  8. Department of Pediatrics, Taipei Medical University, Taipei, Taiwan

    Jeng-Daw Tsai

  9. Department of Pediatrics, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan

    Jeng-Daw Tsai

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  1. Tzu-Hua Lin
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Dr. Hsiang-Ju Lu, Dr. Ming-Dar Lee, and Dr. Brian Pin-Hsuan Chang. The first draft of the manuscript was written by Dr. Tzu-Hua Lin. Dr. Chao-Hsu Lin supervised data collection and critically reviewed the manuscript for endocrinology content. Dr. Jeng-Daw Tsai and Dr. Chun-Chen Lin conceptualized the study and reviewed and revised the manuscript. All authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Jeng-Daw Tsai.

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This retrospective chart review study involving human participants was in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The Human Investigation Committee of Mackay Memorial Hospital approved this study.

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Informed consent was obtained from all individual participants included in the study.

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Patients signed informed consent regarding publishing their data.

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The authors declare no competing interests.

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Lin, TH., Lu, HJ., Lin, CH. et al. Nephrocalcinosis in children who received high-dose vitamin D. Pediatr Nephrol 37, 2471–2478 (2022). https://doi.org/10.1007/s00467-022-05512-6

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  • DOI: https://doi.org/10.1007/s00467-022-05512-6

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