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Vitamina D em crianças e adolescentes com doença renal
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Abstract(s)
Introdução: A vitamina D é uma hormona esteroide, conhecida pelo seu
papel na regulação dos níveis corporais de cálcio e fósforo e na mineralização
óssea. O seu recetor ao estar presente em vários tipos celulares indica-nos
que esta hormona exerce uma ação complexa e harmoniosa sobre um grande
número de mediadores biológicos, vias de sinalização, tipos celulares, órgãos
e sistemas. A insuficiência renal crónica é associada a uma série de distúrbios
do metabolismo mineral e ósseo e acentua a diminuição da síntese da forma
ativa de vitamina D, 1,25(OH)2D. Um défice de vitamina D deve ser
considerado um factor de risco complexo para inúmeras patologias. É
consensual que valores de 25(OH)D <20ng/mL se traduzem em carência
significativa.
Objetivos: O objetivo do estudo foi correlacionar as duas formas de vitamina
D, a vitamina 1,25(OH)2D e a vitamina 25(OH)D com marcadores laboratoriais
da função renal, numa população pediátrica com doença renal. Pretendeu-se
avaliar o défice de vitamina D e verificar a sua relação com o grau de
insuficiência renal.
Material e Métodos: Entre outubro de 2014 e setembro de 2015, foram
recolhidas 89 de amostras de plasma de crianças e adolescentes que
recorreram ao Centro Hospitalar e Universitário de Coimbra - Hospital
Pediátrico. As amostras foram armazenadas para posterior doseamento da
vitamina 1,25(OH)2D e da vitamina 25(OH)D, sendo que a vitamina 25(OH)D
foi doseada em dois momentos diferentes do ano (inverno e verão). Ambas
foram doseadas com recurso ao autoanalisador e kits LIAISON®, Dia-Sorin
Inc. Todos os resultados obtidos foram analisados com recurso ao software
IBM-SPSS versão 22.
Resultados: Nas 89 amostras avaliadas, a etiologia da doença renal era
bastante heterogénea, sendo que as anomalias congénitas representavam a
sua principal causa. Observou-se uma diminuição dos níveis de vitamina
25(OH)D nos indivíduos em estudo, sendo mais evidente no período de
inverno, e não parecendo estar relacionada com a progressão da doença
renal crónica (DRC). O declínio de vitamina 25(OH)D pareceu estar associado
a um aumento da paratormona (PTH) em todos os estadios da DRC, existindo
entre ambas uma correlação inversa. Por sua vez, a diminuição da taxa de
filtração glomerular (TFG) pareceu estar correlacionada com os níveis de PTH
mais elevados e com valores aumentados de creatinina. Não se verificou
qualquer correlação entre os indivíduos que tomavam ou não suplemento de
vitamina 1,25(OH)2D e os níveis plasmáticos de vitamina 25(OH)D. Porém, os
indivíduos que se encontravam numa fase mais inicial da DRC apresentavam
valores de 1,25(OH)2D mais elevados, apesar de serem valores médios
considerados normais.
Discussão e Conclusão: A deficiência em vitamina 25(OH)D na população
em estudo foi ao encontro do que ocorre a nível mundial. O resultado médio
do doseamento de vitamina 1,25(OH)2D foi considerado normal, no entanto
em 17% das amostras, obtivemos valores abaixo de 25pg/mL, assim seria de
ponderar a utilidade do seu doseamento para monitorizar a toma, nos
indivíduos com IRC. A correção de níveis de vitamina D desde as idades
pediátricas mais precoces poderá constituir uma das medidas mais
importantes na saúde pública preventiva. As informações obtidas podem
contribuir para melhorar a assistência a crianças portadoras de DR.
Introduction: Vitamin D is a steroid hormone, known for its role in regulating body levels of calcium and phosphorus and bone mineralization. Its receptor being present in several cell types indicates that this hormone exerts a complex and harmonious action on a large number of biological mediators, signaling pathways, cell types, organs and systems. Chronic renal failure is associated with a variety of mineral and bone metabolism disorders and markedly decreased synthesis of the active form of vitamin D, 1,25(OH)2D. A deficit of vitamin D should be considered a complex risk factor for numerous pathologies. It is consensual that values of 25(OH)D <20ng/mL translate into significant lack. Objectives: The aim of the study was to correlate the two forms of vitamin D, vitamin 1,25(OH)2D and vitamin 25(OH)D with the results of laboratory markers of renal function in pediatric population with renal disease. It is thus expected to assess the vitamin D deficiency and to verify its relationship with the degree of renal failure. . Material & Methods: Between October 2014 and September 2015, 89 samples of plasma from children and adolescents were collected from the Hospital and University Center of Coimbra - Pediatric Hospital. The samples were stored for subsequent assay of vitamin 1,25(OH)2D and vitamin 25(OH)D, this last one was dosed in two different moments (summer and winter). Both were assayed using the LIAISON® Dia-Sorin Inc. selfanalyzer and kits. All results were statistically analyzed using IBM-SPSS software version 22. Results: In 89 samples, the etiology of renal disease is highly heterogeneous and congenital anomalies are the main cause. There was a decrease in vitamin 25(OH)D D levels in the study subjects, which is more evident in the winter period and does not appear to be related to the progression of chronic renal disease (CKD). Decreased of vitamin 25(OH)D is associated with an increase in parathyroid hormone (PTH) at all stages of CKD, with an inverse correlation between both. In turn, the decrease in glomerular filtration rate (GFR) is correlated with higher PTH levels and with increased creatinine values. There was no correlation between individuals taking vitamin 1,25(OH)2D supplement and plasma levels of vitamin 25(OH)D. However, individuals who are in early stage of CKD feature amounts of 1,25(OH)2D higher, although average normal values. I Discussion and Conclusion: The deficiency in vitamin 25(OH)D in the population studied was in line with what happens worldwide. The result of vitamin 1,25(OH)2D on average was considered normal, however in 17% of the sample, we obtained values below 25pg/mL, we would consider the usefulness of its dosage to monitor the intake in subjects with IRC. The correction of vitamin D levels from the earliest pediatric ages may be one of the most important preventive public health measures. The information obtained can contribute to improving care for children with DR.
Introduction: Vitamin D is a steroid hormone, known for its role in regulating body levels of calcium and phosphorus and bone mineralization. Its receptor being present in several cell types indicates that this hormone exerts a complex and harmonious action on a large number of biological mediators, signaling pathways, cell types, organs and systems. Chronic renal failure is associated with a variety of mineral and bone metabolism disorders and markedly decreased synthesis of the active form of vitamin D, 1,25(OH)2D. A deficit of vitamin D should be considered a complex risk factor for numerous pathologies. It is consensual that values of 25(OH)D <20ng/mL translate into significant lack. Objectives: The aim of the study was to correlate the two forms of vitamin D, vitamin 1,25(OH)2D and vitamin 25(OH)D with the results of laboratory markers of renal function in pediatric population with renal disease. It is thus expected to assess the vitamin D deficiency and to verify its relationship with the degree of renal failure. . Material & Methods: Between October 2014 and September 2015, 89 samples of plasma from children and adolescents were collected from the Hospital and University Center of Coimbra - Pediatric Hospital. The samples were stored for subsequent assay of vitamin 1,25(OH)2D and vitamin 25(OH)D, this last one was dosed in two different moments (summer and winter). Both were assayed using the LIAISON® Dia-Sorin Inc. selfanalyzer and kits. All results were statistically analyzed using IBM-SPSS software version 22. Results: In 89 samples, the etiology of renal disease is highly heterogeneous and congenital anomalies are the main cause. There was a decrease in vitamin 25(OH)D D levels in the study subjects, which is more evident in the winter period and does not appear to be related to the progression of chronic renal disease (CKD). Decreased of vitamin 25(OH)D is associated with an increase in parathyroid hormone (PTH) at all stages of CKD, with an inverse correlation between both. In turn, the decrease in glomerular filtration rate (GFR) is correlated with higher PTH levels and with increased creatinine values. There was no correlation between individuals taking vitamin 1,25(OH)2D supplement and plasma levels of vitamin 25(OH)D. However, individuals who are in early stage of CKD feature amounts of 1,25(OH)2D higher, although average normal values. I Discussion and Conclusion: The deficiency in vitamin 25(OH)D in the population studied was in line with what happens worldwide. The result of vitamin 1,25(OH)2D on average was considered normal, however in 17% of the sample, we obtained values below 25pg/mL, we would consider the usefulness of its dosage to monitor the intake in subjects with IRC. The correction of vitamin D levels from the earliest pediatric ages may be one of the most important preventive public health measures. The information obtained can contribute to improving care for children with DR.
Description
Keywords
1,25 dihidroxivitamina D (1,25(OH)2D) 25- hidroxivitamina D (25(OH)D) Doença renal Nefropatias