The Impact of Bone Mineral Biomarkers on Cardiac Dysfunction in Predialysis Chronic Kidney Disease Children

ACTUALITIES IN THE MANAGEMENT OF SECONDARY HYPERPARATHYROIDISM DUE TO CHRONIC KIDNEY DISEASE IN CHILDREN

Pediatric chronic kidney disease (CKD) has a substantial global impact because is associated with notable morbidity. Secondary hyperparathyroidism (SPHT) frequently emerges as a complication in the early stages of renal insufficiency, it is an adaptive response to uphold mineral balance. It is a component of the chronic kidney disease-mineral and bone disorder (CKD-MBD). The development of SHPT in CKD involves multiple factors and it is important to understand them in order to properly manage it, starting with early diagnosis and continuing with proper treatment. In children with CKD and SHPT, the difficulty in case management is due to non-adherence to proper diet which makes it difficult for the pediatric nephrologist to manage the case. In this review we want to focus on new data regarding this CKD complication.

The clinical relevance of native vitamin D in pediatric kidney disease

Hypovitaminosis D has been reported to be common in chronic kidney disease (CKD) as well as in proteinuric disorders. We reviewed available evidence to assess clinically relevant effects of low vitamin D status and native vitamin D (NVD) therapy, in pediatric renal diseases. Online medical databases were searched for articles related to vitamin D status, associations of hypovitaminosis D and effects of NVD therapy in kidney disease. Hypovitaminosis D was associated with worse skeletal, cardiovascular, inflammatory, and renal survival outcomes in CKD. Low serum 25 hydroxy-vitamin D (25[OH]D) levels correlated positively with glomerular filtration rate and negatively with serum parathyroid (PTH) levels. However, to date, evidence of benefit of NVD supplementation is restricted mainly to improvements in serum PTH, and biochemical 25[OH]D targets form the basis of clinical practice recommendations for NVD therapy. In nephrotic syndrome (NS) relapse, studies indicate loss of 25[OH]D along with vitamin D binding protein in urine, and serum total 25[OH]D levels are low. Preliminary evidence indicates that free 25[OH]D may be a better guide to the biologically active fraction. NVD therapy in NS does not show consistent results in improving skeletal outcomes and hypercalciuria has been reported when total 25[OH]D levels were considered as indication for therapy. NVD formulations should be regularised, and therapy monitored adequately to avoid adverse effects.