Efficacy of Usual Vitamin D Supplementation and Its Impact on Children and Adolescents Calciuria.
Condition: Chronic Kidney Disease; Renal Transplantation; Nephrotic Syndrome
MeSH terms: Kidney Diseases; Renal Insufficiency, Chronic; Nephrotic Syndrome; Nephrosis
Study type: Interventional
Phase: Phase 4

Summary: 
      Vitamin D is not seen anymore only as a phosphocalcic and bone hormone, but also as having an
      effect on global health (anti-infective, anti-inflammatory, anti-tumour roles and
      cardiovascular protection).

      Until recently, vitamin D repletion was defined as the minimal concentration that enables the
      prevention of rickets in children and osteomalacia in adults, i.e, approximately 8 ng/mL (20
      nmol/L). However, most of the international experts agree to set minimal threshold of 25 OH
      vitamin D serum concentration, higher than the one previously admitted, with a limit of 20
      ng/mL (50 nmol/L) to define a vitamin D deficiency and a limit of 30 ng/mL (75 nmol/L) to
      define vitamin D insufficiency.

      Recommendations for Vit D supplementation in healthy children were updated in France in 2012.
      The invariable supplementation of infants and toddlers is efficient since deficiency-related
      rickets have almost disappeared; however there is very few information in ill children
      populations.

      Vit D supplementation tolerance is usually considered as good and over-dosage risks are low,
      however these studies were conducted more than 30 years ago, and as far as we know, there is
      no study about calcium urinary excretion kinetics after intake of a 100 000 IU vial of
      cholecalciferol (Uvedose®). When 25 OH vitamin D serum concentrations exceeds 200 ng/mL,
      which is very rare in daily practice, toxic effects of Vit D may theoretically be observed,
      particularly hypercalcemia and hypercalciuria.

      Vitamin D deficit is very common in children with chronic kidney disease (CKD) with a 50 to
      92% prevalence depending on the studies; it it is a risk factor for secondary
      hyperparathyroidism.

      Although international guidelines regarding the care of CKD children recommend 25 OH vitamin
      D serum concentrations over 75 nmol/L, there are no practical recommendations in terms of
      dose and frequency of native Vit D treatment.

      Therefore, the objectives of the present study has are the following:

        -  to validate prospectively the efficacy of our service usual care for Vit D
           supplementation of children and adolescents seen in the paediatric nephrology
           department.

        -  and to study the effect of Vit D supplementation (100 000 IU vial of cholecalciferol) on
           calciuria in these patients.
    


Intervention name(s): Cholecalciferol vial (100 000 UI)
Intervention type(s): Drug
Intervention description(s): VISIT 1:
Patient > 60 kg and initial 25OHD serum concentration < 25nmol/L : prescription of 4 vials to be taken every 2 weeks between 25 and 50 nmol/L: prescription of 3 vials to be taken every 2 weeks between 50 and 75 nmol/L: prescription of 2 vials to be taken every 2 weeks Patient between 20 and 60 kg and initial 25OHD serum concentration < 25nmol/L: prescription of 2 vials to be taken every month between 25 and 50 nmol/L: prescription of 2 vials to be taken every 6 weeks between 50 and 75 nmol/L: prescription of 1 single vial Patient < 20 kg and initial 25OHD serum concentration < 75 nmol/L: prescription of 1 single vial
A local lab will performed urinary dosage of calciuria and creatininuria:
at days 0, 1, 2, 3, 4 and 7 after the first intake of a 25OHD vial
at days 0, 2 and 4 after other intakes (when applicable)
VISIT 2:
25OHD serum concentration will then be dosed at month 2 after visit 1
Intervention MeSH terms: Cholecalciferol; Vitamin D
Intervention model: Single Group Assignment
Masking: None (Open Label)
Primary purpose: Other
Keywords: Vitamin D, Calciuria, Paediatrics, Nephrology