Vitamin D insufficiency and hyperparathyroidism in children with chronic kidney disease

Pediatr Nephrol. 2008 Oct;23(10):1831-6. doi: 10.1007/s00467-008-0842-x. Epub 2008 Jun 25.

Abstract

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.

MeSH terms

  • Adolescent
  • Calcitriol / blood
  • Child
  • Child, Preschool
  • Chronic Disease
  • Female
  • Humans
  • Hyperparathyroidism / etiology*
  • Kidney Diseases / metabolism*
  • Male
  • Parathyroid Hormone / blood
  • Prevalence
  • Retrospective Studies
  • Vitamin D Deficiency / epidemiology*

Substances

  • PTH protein, human
  • Parathyroid Hormone
  • Calcitriol