calcium and vitamin d metabolism in pediatric nephrotic syndrome; an update on the existing literature

minimal change disease (mcd) is the leading cause of childhood nephrotic syndrome (ns). therefore in pediatrics nephrotic syndrome, most children beyond the first year of life will be treated with corticosteroids without an initial biopsy. children with ns often display a number of calcium homeostasis disturbances causing abnormal bone histology, including hypocalcemia, reduced serum vitamin d metabolites, impaired intestinal absorption of calcium, and elevated levels of immunoreactive parathyroid hormone (ipth). these are mainly attributed to the loss of a variety of plasma proteins and minerals in the urine as well as steroid therapy. early diagnosis and management of these abnormalities, could prevent the growth retardation and renal osteodystrophy that affects children with nephrotic syndrome. here we reviewed the literature for changes of calcium and vitamin d metabolism in nephrotic syndrome and its consequences on bones, also the effect of corticosteroid and possible preventive strategies that could be done to avoid long term outcomes in children. although the exact biochemical basis for changes in levels of calcium and vitamin d metabolites in patients with ns remains speculative; because of the potential adverse effects of these changes among growing children, widespread screening for vitamin d deficiency or routine vitamin d supplementation should be considered.