cholecalciferol and Nephrotic-Syndrome

Supplementation of vitamin D in food is available in Japan, therefore, vitamin D deficiency is not likely to occur in our country. But, in the case of nephrotic syndrome and strict dietary protein restriction, low serum 25(OH)D level might develop in chronic kidney disease (CKD)patients. Guideline issued by National Kidney Foundation as DOQI recommend the use of vitamin D2 (ergocalciferol) when serum 25(OH)D level in CKD patients become less than 30 ng/mL. In addition, for the CKD patients with stage 5, the use of active vitamin D3 is recommended because a conversion to 1,25(OH)2D3, which is the most potent vitamin D, might be impossible in these patients. However, vitamin D2 product as a supplementary medicine is not available in Japan unfortunately. In this context, I try to explain the background of the recommendation of vitamin D2 for CKD patients.

Topics: Biomarkers; Cholecalciferol; Diet, Protein-Restricted; Ergocalciferols; Humans; Kidney Failure, Chronic; Nephrotic Syndrome; Practice Guidelines as Topic; Vitamin D; Vitamin D Deficiency

Body stores of vitamin D are measured as "total" serum 25-hydroxy vitamin D (25(OH)D). Its largest component is protein bound and lost in urine in nephrotic syndrome (NS). Our study investigates whether "free" 25(OH)D levels are a better guide to bone health and need for vitamin D supplementation in patients with steroid-sensitive NS (SSNS).. A cross-sectional study was performed in children with SSNS and healthy controls. Blood was tested for albumin, creatinine, calcium, phosphate, ALP, total and free (by direct ELISA) 25(OH)D, iPTH, and urine for protein-creatinine ratio.. These results confirm that total 25(OH)D levels are low in NS and related to degree of proteinuria. However levels of free 25(OH)D, ALP, and iPTH did not change in relapse or remission in comparison with healthy controls. Our results suggest that in proteinuric renal diseases, free 25(OH)D rather than total 25(OH)D levels should be used to diagnose vitamin D deficiency and guide therapy.

Topics: Case-Control Studies; Child; Child, Preschool; Cholecalciferol; Cross-Sectional Studies; Dietary Supplements; Ergocalciferols; Female; Glucocorticoids; Humans; Male; Nephrotic Syndrome; Proteinuria; Risk Factors; Serum Albumin, Human; Severity of Illness Index; Vitamin D Deficiency

Puromycin aminonucleoside-induced nephrotic syndrome (PAN-NS) is characterized by cardiac remodeling and increased local inflammatory activity. Patients with NS and animal models of NS have vitamin D3 deficiency. The aim of the present study was to evaluate the influence of calcitriol on cardiac remodeling and local inflammatory state in PAN-NS rat model. Male Sprague-Dawley rats were injected with PAN or vehicle on day 0. PAN and control rats were divided into two subgroups for the administration of calcitriol (PAN-D and Ct-D groups) or the vehicle (PAN-V and Ct-V groups) during 21 days. On day 21, the renal function, metabolic balance, calcitriol and FGF-23 plasma levels, prohypertrophy and proinflammatory markers (ET-1, TGF-

Topics: Animals; Calcitriol; Cardiomegaly; Cholecalciferol; Cytokines; Fibroblast Growth Factor-23; Humans; Male; Nephrotic Syndrome; Puromycin Aminonucleoside; Rats; Rats, Sprague-Dawley

Klippel-Trenaunay-Weber syndrome is a rare syndrome; unfortunately, very few studies of the connection between hypersplenism, nephrotic syndrome, and Klippel-Trenaunay-Weber syndrome have been published.. We report the case of a 40-year-old white man with a typical clinical presentation of Klippel-Trenaunay-Weber syndrome, including "port-wine stains," varicose veins, hypertrophy of lower extremities, and arteriovenous fistula, as well as an unfortunate development of hypersplenism and nephrotic syndrome.. This case report described considerable atypical relevance of Klippel-Trenaunay-Weber syndrome and hypersplenism together with nephrotic syndrome. A multidisciplinary approach was made. Unfortunately, hypersplenism is characterized by pancytopenia that suggests splenectomy, whereas nephrotic syndrome is an indication for renal biopsy; the splenectomy and renal biopsy were delayed due to our patient's severe condition. Deeper analysis including study of other patients with Klippel-Trenaunay-Weber syndrome would help us to understand the connection between elevated spleen and liver sizes, nephrotic syndrome, and Klippel-Trenaunay-Weber syndrome.

Topics: Adult; Allopurinol; Amlodipine; Angiotensin-Converting Enzyme Inhibitors; Anticholesteremic Agents; Antihypertensive Agents; Arteriovenous Fistula; Atorvastatin; Cholecalciferol; Erythrocyte Transfusion; Humans; Hypersplenism; Klippel-Trenaunay-Weber Syndrome; Male; Nephrotic Syndrome; Perindopril; Port-Wine Stain; Vitamins

The possibility to achieve and maintain normal plasma levels of 25-hydroxyvitamin D3 (25OHD3), with long-term vitamin D replacement therapy, has been evaluated in 9 patients with nephrotic syndrome. Plasma levels of 25OHD3 rose from 10.8 +/- 5.0 (SD) nmol/l to 29.5 +/- 11.1 (p less than 0.001) with a daily dose of 25 micrograms of vitamin D3 per os. Plasma levels of 1,25-dihydroxyvitamin D3 were low before treatment (39.5 +/- 22.7 pmol/l) and returned to the normal range under therapy in the patients without renal failure. Low levels of vitamin D metabolites in nephrotic syndrome can be normalized with long-term oral vitamin D replacement therapy.

Topics: Adult; Aged; Calcifediol; Calcitriol; Cholecalciferol; Female; Humans; Male; Middle Aged; Nephrotic Syndrome; Vitamin D Deficiency

The generic term "Renal Osteodystrophy" is used to denote a complex of skeletal and metabolic impairments found in nephropathic patients. Neither dialytic treatment nor transplant is always capable of limiting the worsening evolution; transplantation, on the contrary, while it does not in many cases bring the phospho-calcic metabolism back to full normality, introduces new elements of imbalance arising as a result of the inevitable immunosuppressive therapy. After outlining the main post-transplant metabolic problems, the Authors discuss the manifestations of orthopaedic interest, in particular the most severe complication, i.e. aseptic necrosis.

Topics: Cholecalciferol; Chronic Kidney Disease-Mineral and Bone Disorder; Femur Head Necrosis; Hip Prosthesis; Humans; Kidney Transplantation; Metabolic Diseases; Nephrotic Syndrome; Osteonecrosis; Osteosclerosis; Parathyroid Hormone; Postoperative Complications; Radiography

Using newly developed and established extraction, Lipidex-5000 chromatography, normal phase gradient HPLC, and ligand binding assay techniques we have directly measured plasma and urine levels of vitamin D3 and its metabolites in seven normal subjects and seven patients with nephrotic syndrome and normal renal function. Significant reductions in the plasma levels of vitamin D3, 24,25(OH)2D3, 25,26(OH)2D3, and 1,25(OH)2D3 were noted in all nephrotic patients. In conjunction with the plasma metabolite abnormalities, direct quantitative analysis of the urine in these patients revealed significant increases in nonconjugated 250HD3, 24,25(OH)2D3 and 1,25(OH)2D3. Significant correlations were noted between the plasma and/or urine metabolites and other mineral homeostatic parameters. The results indicate that the primary basis for the reductions in plasma vitamin D3 and its metabolites in the nephrotic syndrome is enhanced urinary excretion. The findings of normal serum ionized Ca and i-PTH levels in the patients with nephrosis suggest that reductions in bound and not free forms of vitamin D3 metabolites in plasma may occur in the initial stages of the nephrotic syndrome.

Topics: Calcium; Cholecalciferol; Humans; Nephrotic Syndrome; Parathyroid Hormone; Serum Albumin

Endotoxin-stimulated NBT-tests were carried out in 15 patients with hypocalcemia of varying etiology and in 14 normocalcemic children free of infection. In the control group the formazan cell percentage (FCP) was 73.8 +/- 1.6% (range 63% to 83%). In 5 patients with hypoparathyroidism or pseudohypoparathyroidism the FCP before treatment was lower than normal. Vitamin D3 therapy produced a rapid increase of serum calcium but normalisation of NBT-test was only achieved after a latent period of one or more months. Patients with hypocalcemic rickets and children with an acute relapse of the nephrotic syndrome also showed abnormal results. The clinical significance of the NBT-test in hypocalcemic conditions is discussed.

Topics: Adolescent; Adult; Child; Child, Preschool; Cholecalciferol; Endotoxins; Female; Humans; Hypocalcemia; Hypoparathyroidism; Infant; Lymphocyte Activation; Male; Nephrotic Syndrome; Nitroblue Tetrazolium; Pseudohypoparathyroidism; Rickets; Tetrazolium Salts

Plasma concentrations of 25-hydroxy-cholecalciferol (25-OHD3) and vitamin-D-binding globulin (V.D.B.G.) were significantly reduced in ten nephrotic subjects. V.D.B.G., which is undetectable in normal urine, was present in substantial amounts in the urine of each nephrotic subject. Administration of 3H-labelled cholecalciferol to three subjects resulted in the rapid appearance of the labelled vitamin in the urine, mainly as the 25-hydroxylated metabolite bound to V.D.B.G. in amounts which could largely account for the low plasma-25-OHD3. The plasma half-life of 25-OHD3 was substantially reduced in the nephrotic syndrome.

Topics: Adult; Aged; Alkaline Phosphatase; Cholecalciferol; Chromatography; Female; Globulins; Half-Life; Humans; Isotope Labeling; Male; Middle Aged; Nephrotic Syndrome; Protein Binding; Proteinuria; Serum Albumin; Serum Globulins; Tritium; Vitamin D

Topics: Absorptiometry, Photon; Adrenal Cortex Hormones; Bone and Bones; Bone Diseases; Child; Cholecalciferol; Cobalt Isotopes; Humans; Iodine Radioisotopes; Lead; Methods; Microradiography; Minerals; Nephrotic Syndrome; Osteoporosis; Radioisotopes; Rickets

The absorption and metabolism of vitamin D(3)-(3)H was studied in eight patients with chronic renal failure. Although the intestinal absorption of vitamin D(3)-(3)H was normal, the metabolic fate of the vitamin was abnormal as characterized by a twofold increase in fractional turnover rate, an abnormal accumulation of biologically inactive lipid-soluble metabolites, and the urinary excretion of both vitamin D(3)-(3)H and biologically inactive metabolites. Neither alterations in water-soluble vitamin D(3) metabolites nor qualitative abnormalities in protein-binding of vitamin D(3) were observed in the uremic subjects. Although hemodialysis proved ineffectual in reversing the observed abnormalities in vitamin D(3) metabolism and excretion, renal homotransplantation was completely successful in this regard. These experiments support the conclusion that the resistance to therapeutic doses of vitamin D often seen in patients with chronic renal failure and renal osteodystrophy results from an acquired defect in the metabolism and excretion of vitamin D.

Topics: Adult; Alkaline Phosphatase; Animals; Biological Assay; Blood Urea Nitrogen; Chloroform; Cholecalciferol; Chromatography; Electrophoresis; Feces; Female; Glomerulonephritis; Humans; Kidney Failure, Chronic; Kidney Transplantation; Male; Nephrotic Syndrome; Proteinuria; Pyelonephritis; Rats; Renal Dialysis; Transplantation, Homologous; Tritium