A study on the metabolic bone profile of adult onset nephrotic syndrome patients

Background: Adult onset nephrotic syndrome patients following primary glomerular diseases receive one or more immunosuppressive agents. Glucocorticoids and Tacrolimus are the most commonly used agents in nephrotic syndrome.It is widely known that glucocorticoids induce and accelerate osteoporosis. High-dose glucocorticoids are administrated daily to patients in the acute phase of nephrotic syndrome in both adult and children. Tacrolimus,a calcineurin inhibitor, commonly used in the post renal transplant setting is being used as a steroid sparing agent in adult onset nephrotic syndromes. Materials and Methods: A total of 46 patients of Adult onset nephrotic syndrome patients were studied.25 of them were on prednisolone regimen at1mg/Kg body weight/day, as per KDIGO guidelines and 21 were on Tacrolimus 0.075 mg/Kg/day in two divided doses regimen. Bone mineral density (BMD) was studied at the lumbar vertebral level (L1-L4) by BMD DEXA Scan at 0, 3 months and 6 months.
Results: Our study revealed the deleterious effect of glucocorticoids on the bone health of young individuals. Tacrolimus has also caused significant loss of BMD in the study subjects as has been shown in the post transplant settings in various studies.
Conclusion: It could be inferred that inspite of calcium and vitamin D supplementation high-dose glucocorticoids as well as Tacrolimus rapidly decrease patient’s basal bone mineral density (BMD).