Study on Bone Mineral Density in Adults with Nephrotic Syndrome.

Introduction: The nephrotic syndrome is one of the best known clinical presentations of adult or pediatric nephropathy. Nephrotic syndrome is characterized by the association of heavy proteinuria with pedal edema, hypoalbuminemia, and hypercholesterolemia. Aims: To compare and correlate bone mineral density with biochemical parameters like serum calcium, phosphorus, vitamin-D, alkaline phosphatase, albumin and parathyroid hormone, in adults with nephrotic syndrome. Methodology: The study was Cross sectional observational study. The conducted in adult patients with nephrotic syndrome above 18 years of age with no primary bone pathology or metastatic disease. Biochemical parameters were assessed and correlated with bone mineral density by DXA scan of lumbar spine and neck of femur. Fifty patients of command hospital Kolkata (EC) were selected and compared with equal number of age and sex matched controls. All patients were selected from a period of 01 Jan 18 to 31 May 19. All underwent detailed clinical examination and investigations were done at the time of recruitment. Results: DXA scan results in cases of nephrotic syndrome show significantly low BMD for both lumbar spine and neck of femur with mean Z-scores less than -1.0 (P<0.001). Lumbar spine (L1-L4): Low BMD was found in 88 percent cases and 32 percent of controls (P < 0.001). Neck of femur: Low BMD was found in 44 percent cases and 10 percent controls (P<0.001). Cases with normal BMD had statistically significant lower levels of blood urea with mean 23 ± 4.53 mg/dl. Cases with osteopenia and osteoporosis had higher levels of blood urea with mean 54.13 ± 32.4 mg/dl and 66.85 ± 29.64 mg/dl respectively. Cases with normal BMD had higher levels of serum calcium with mean 7.67 ± 1.01 mg/dl. Cases with osteopenia and osteoporosis had serum calcium with mean 7.22 ± 0.88mg/dl and 7.26 ± 0.68 mg/dl respectively. However this comparison did not reach any statistical significance. Conclusion: Adults with nephrotic syndrome are at risk for low bone mineral density. These patients should undergo regular evaluations for mineral bone diseases and appropriate therapeutic interventions should be planned. [ABSTRACT FROM AUTHOR]