Urinary calcium and bone mineral density in children with nephrotic syndrome treated with glucocorticoids


  • Sharanagouda Patil Department of Paediatrics, M R Medical College, Kalaburagi, Karnataka, India
  • Sanjeev Reddy Department of Paediatrics, M R Medical College, Kalaburagi, Karnataka, India




Bone mineral density, Glucocorticoids, Osteoporosis, Quantitative ultrasound, Urinary calcium


Background: Mainstay of therapy in the idiopathic nephrotic syndrome is glucocorticoids. Glucocorticoid induced osteoporosis is considered as most prevalent type of secondary osteoporosis. Only limited studies are conducted in tropical nations. Therefore our study is undertaken with objectives to evaluate Glucocorticoid therapy impact on bone health in Nephrotic Syndrome (NS) children by 2 different tools, namely urinary calcium and bone mineral density (BMD) by Quantitative ultrasound (QUS) and compare both the tools.

Methods: Total 42 children with NS who completed minimum 12 weeks of Glucocorticoid therapy (6 weeks of daily regimen and minimum 6 weeks of alternate day regimen) were subjected to 24 hour Urinary calcium and Bone Mineral density by QUS at Tertiary health centre, Kalaburagi.

Results: Out of 42 cases, 45.2 % had Osteopenia and 2.4% had osteoporosis, so 47.6% of them had BMD measured by QUS. Hypercalciurea was seen in 10 out of 42 cases (23.8%). In normal BMD group only 0.5% had hypercalciurea, Osteopenia group had 47.4% of cases and all osteoporosis group had hypercalciurea.

Conclusions: Present study data concludes that children with NS treated with Glucocorticoids are at risk of Negative impact on bone health. Though both the tools detect impact of Glucocorticoids on bone health, BMD by QUS has better rate then urinary calcium in detecting negative effect of Glucocorticoid on bone health. As BMD by QUS decreases, Urinary calcium increases reflecting inverse relation between them.


Nash MA, Edelmann CM, Bernstein J, Barnett HL. The nephritic syndrome. Volume II. Pediatric Kidney Disease, 2nd edition. Boston: Little Brown and Company; 1992:1247-1266.

Goldstein DA, Haldimann B, Sherman D, Norman AW, Massry SG. Vitamin D metabolites and calcium metabolism in patients with nephrotic syndrome and normal renalfunction. J Clin Endocrinol Metab. 1981;52:116-21.

Gulati S, Godbole M, Singh U, Gulati K, Srivastava A. Are children with idiopathic nephrotic syndrome at risk for metabolic bone disease?. Am J Kidney Dis. 2003;41:1163-9.

van Staa TP, Cooper C, Leufkens HG, Bishop N. Children and the risk of fractures caused by oral corticosteroids. J Bone Miner Res. 2003;18:913-8.

Mazziotti G, Angeli A, Bilezikian JP, Canalis E, Giustina A. Glucocorticoid-induced osteoporosis: an update. Trends in Endocrinol Metab. 2006 May 1;17(4):144-9.

Boraey NF, Addosooki A, Mohammad MA, Marwa M, El-Sonbaty, Toukhy SE. Metabolic Bone Disease in Children with Idiopathic Nephrotic Syndrome. Life Sci J. 2012;9(4):275-80.

Baroncelli G. Quantitative Ultrasound Methods to Assess Bone Mineral Status in Children: Technical Characteristics, Performance, and Clinical Application. Pediatr Res. 2008;63:220-8

World Health Organization (1994). Assessment of fracture risk and its application to screening for osteoporosis. Report of a WHO Study Group. World Health Org Tech Rep Ser. 1994;843:1-129

Mortazavi F, Khiavi YS. Steroid response pattern and outcome of pediatric idiopathic nephrotic syndrome: a single-center experience in northwest Iran. Therapeutics and clinical risk management. 2011;7:167.

Banerjee S, Basu S, Sengupta J. Vitamin D in nephrotic syndrome remission: a case-control study. Pediatr Nephrol. 2013 Oct;28(10):1983-9.

Prasun B, Payas J, Sujaya M. Prediction of relapses in children with idiopathic steroid sensitive nephritic syndrome: A retrospective study. Int J Contemp Pediatr. 2017 Jan;4:57-61.

Bakhiet YM, Mudi A, Khumalo T, Moonsamy G, Levy C. Idiopathic nephrotic syndrome in South African children. African Health Sciences. AJOL. 2018 Jan8;17(4):1130.

El Bakkali L, Rodrigues Pereira R, Kuik DJ, Ket JC, van Wijk JA. Nephrotic syndrome in The Netherlands: a population-based cohort study and a review of the literature. Pediatr Nephrol. 2011;26(8):1241-6.

Mohan KR, Kanitkar M. Growth in Children with Steroid Sensitive Nephrotic Syndrome. Med J Armed Forces India. 2009;65(1):4-6.

Lestari N, Nurani N, Julia M. Corticosteroids and obesity in steroid-sensitive and steroid-resistant nephrotic syndrome. Paediatr Indonesiana. 2015 Jul 31;55(4):194-8.

Klepikov PV, Kutyrina IM, Tareyeva IE. Steroid-induced hypertension in patients with nephrotic syndrome. Nephron. 1988;48:286-90.

Lewiecki EM, Gordon CM, Baim S, Leonard MB, Bishop NJ, Bianchi ML, et al. International Society for Clinical Densitometry 2007 adult and pediatric official positions. Bone. 2008 Dec 1;43(6):1115-21.

El-Mashad GM, El-Hawy MA, El-Hefnawy SM, Mohamed SM. Bone mineral density in children with idiopathic nephrotic syndrome. J Pediatr (Rio J). 2017;93:142-7

Gulati S, Sharma RK, Gulati K, Singh U, Srivastava A. Longitudinal follow-up of bone mineral density in children with nephrotic syndrome and the role of calcium and vitamin D supplements. Nephrol Dialysis Transplantation. 2005;20(8):1598-603.

Aceto G, D’Addato O, Messina G, Carbone V, Cavallo L, Brunetti G, et al. Bone health in children and adolescents with steroid-sensitive nephrotic syndrome assessed by DXA and QUS. Pediatr Nephrol. 2014 Nov;29(11):2147-55.

Basiratnia M, Fallahzadeh MH, Derakhshan A, Hosseini-Al-Hashemi G. Bone mineral density in children with relapsing nephritic syndrome. Iran J Med Sci. 2006;31(2)82-6.

Leonard MB, Feldman HI, Shults J, Zemel BS, Foster BJ, Stallings VA. Long-term, highdose glucocorticoids and bone mineral content in childhood glucocorticoid-sensitive nephritic syndrome. N Engl J Med. 2004;351:868-75.

Güngör SS, Sönmez F, Yılmaz D. The Effect of Corticosteroids on Urinary Calcium Excretion. A Pilot Study. J Clin Anal Med. 2016;7(4):524-8.

Koşan C, Ayar G, Orbak Z. Effects of steroid treatment on bone mineralme-tabolism in children with glucocorticoid-sensitive nephrotic syndrome. WestIndian Med J. 2012;61:627-30.






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