Vitamin D insufficiency and hyperparathyroidism in children with chronic kidney disease.
Chronic kidney disease (CKD) is associated with altered calcium-phosphate homeostasis and hyperparathyroidism due to decreased activity of 1alpha-hydroxylase and impaired activation of 25-hydroxyvitamin D3 [25(OH)D3]. In some patients these problems start earlier because of vitamin D deficiency. A retrospective review of patients followed in the chronic renal insufficiency clinic at Children's Hospital of Michigan assessed the prevalence of vitamin D deficiency in CKD stages 2-4 and evaluated the effect of treatment with ergocalciferol on serum parathormone (PTH). Blood levels of 1,25 dihydroxyvitamin D3, 25(OH)D3, and parathormone (PTH) were examined in 57 children (40 boys; mean age 10.6 years). Of 57 subjects, 44 (77.2%) had 25(OH)D3 levels < or =30 ng/ml, with overall mean of 26.4 +/- 14.3 ng/ml. PTH for patients with 25(OH)D3 levels >30 ng/ml was 67.84 +/- 29.09 ng/ml and in the remaining patients was elevated, at 120.36 +/- 86.42 ng/ml (p = 0.05). Following ergocalciferol treatment (22), PTH decreased from 122.13 +/- 82.94 ng/ml to 80.14 +/- 59.24 ng/ml (p < 0.001) over a period of 3 months. We conclude that vitamin D deficiency is common in children with CKD stages 2-4 and is associated with hyperparathyroidism in the presence of normal 1,25 dihydroxyvitamin D3. Its occurrence before significant renal impairment is noteworthy. Early diagnosis and appropriate treatment is emphasized.
Menon
Shina
S
Division of Pediatric Nephrology and Hypertension, Children's Hospital of Michigan, Detroit, MI 48201, USA. smenon@dmc.org
Valentini
Rudolph P
RP
Hidalgo
Guillermo
G
Peschansky
Lena
L
Mattoo
Tej K
TK
D000293:Adolescent; D002117:Calcitriol / Q000097:blood; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D005260:Female; D006801:Humans; D006961:Hyperparathyroidism / Q000209:etiology*; D007674:Kidney Diseases / Q000378:metabolism*; D008297:Male; D010281:Parathyroid Hormone / Q000097:blood; D015995:Prevalence; D012189:Retrospective Studies; D014808:Vitamin D Deficiency / Q000453:epidemiology*
C470125:PTH protein, human; D010281:Parathyroid Hormone; D002117:Calcitriol