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Abstract: SA-PO217

To Study the Association of Bone Mineral Density With Clinical Activity in Adult-Onset Nephrotic Syndrome

Session Information

Category: Bone and Mineral Metabolism

  • 402 Bone and Mineral Metabolism: Clinical

Authors

  • Prabhahar, Arun, Post Graduate Institute of Medical Education and Research, Chandigarh, Chandigarh, India
  • Johal, Prabhjot Kaur, Post Graduate Institute of Medical Education and Research, Chandigarh, Chandigarh, India
  • Bharati, Joyita, Post Graduate Institute of Medical Education and Research, Chandigarh, Chandigarh, India
  • Kumar, Vinod, Post Graduate Institute of Medical Education and Research, Chandigarh, Chandigarh, India
  • Ramachandran, Raja, Post Graduate Institute of Medical Education and Research, Chandigarh, Chandigarh, India
Background

Nephrotic syndrome and its treatment culminate in multifarious bone and mineral metabolism abnormalities. Dual Energy X-ray Absorptiometry (DEXA) scan predicts bone mineral density (BMD) alterations in children with Nephrotic syndrome. Bioavailable 25(OH)-vitamin D (free plus albumin-bound) is a better measurement of vitamin D status than total 25(OH)-Vitamin D. There is a paucity of clinical studies evaluating BMD and bioavailable 25(OH)-vitamin D and its association with clinical activity in patients with adult-onset nephrotic syndrome.

Methods

We partook in a prospective observational study in adult-onset nephrotic syndrome (podocytopathy or primary membranous nephropathy) followed-up for 1-year. Patients underwent bioavailable 25(OH)-Vitamin D levels and DEXA (Dual Energy X-ray Absorptiometry) scan before and after 1-year of immunosuppressive therapy. We determined the bioavailable 25 (OH)-Vitamin D using modified Vermeulen Equations. All patients received steroid-based therapy consistent with the current standard of care along with vitamin D and calcium supplementation. Remission was defined as per the latest KDIGO 2021 clinical practice guideline for the management of Glomerular disease.

Results

We enrolled a total of 30 patients in the study. The median proteinuria, serum albumin and creatinine at baseline were 7.1 gm/day (5.25, 15.5), 2.34 gm/dl (2, 2.26) and 0.945 mg/dl (0.70, 1.25), respectively. The median bio-available 25(OH)-Vitamin D significantly increased from 3.67 ng/mL (1.29, 6.44) to 16.86 ng/mL (8.24, 28.16) (p<0.001). But, the BMD of the lumbar spine and the hip did not change significantly from the baseline (0.91±0.12 g/cm2 and 0.94 ± 0.14 g/cm2 to 0.89± 0.12 g/cm2 and 0.91 ± 0.11 g/cm2 respectively). No significant change was observed in bio-available 25(OH)-Vitamin D and BMD (both hip and lumbar spine) between those who achieved remission and those who did not.

Conclusion

Treatment of nephrotic syndrome with immunosuppressive therapy is not associated with BMD decline. Reduction in proteinuria along with calcium and vitamin D supplementation probably mitigates the deleterious impact of steroids on BMD in patients with nephrotic syndrome.

Funding

  • Government Support – Non-U.S.