Disease Activity, Proteinuria, and Vitamin D Status in Children with Systemic Lupus Erythematosus and Juvenile Dermatomyositis

• Published in: The Journal of pediatrics Vol. 160; no. 2; pp. 297 - 302
• Main Authors: Robinson, Angela Byun, Thierry-Palmer, Myrtle, Gibson, Keisha L., Rabinovich, Consuelo Egla
• Format: Journal Article
• Language: English
• Published: Maryland Heights, MO Mosby, Inc 01.02.2012; Elsevier
• Subjects: Adolescent; adrenal cortex hormones; analogs & derivatives; binding proteins; Biological and medical sciences; blood; blood serum; Child; children; complications; creatinine; Creatinine - urine; dermatomyositis; Dermatomyositis - blood; Dermatomyositis - physiopathology; Dermatomyositis - urine; Female; General aspects; Humans; linear models; lupus erythematosus; Lupus Erythematosus, Systemic; Lupus Erythematosus, Systemic - blood; Lupus Erythematosus, Systemic - physiopathology; Lupus Erythematosus, Systemic - urine; Male; Medical sciences; Nephrology. Urinary tract diseases; patients; Pediatrics; physiopathology; Prospective Studies; proteinuria; Proteinuria - urine; Risk Factors; Sarcoidosis. Granulomatous diseases of unproved etiology. Connective tissue diseases. Elastic tissue diseases. Vasculitis; Severity of Illness Index; Urinary system involvement in other diseases. Miscellaneous; Urinary tract. Prostate gland; urine; vitamin D; Vitamin D - analogs & derivatives; Vitamin D - blood; vitamin D deficiency; Vitamin D Deficiency - blood; Vitamin D Deficiency - complications; Vitamin D Deficiency - physiopathology; Vitamin D Deficiency - urine; vitamin status; eGFR; SLEDAI; JDM; DBP; 25(OH)D; UP/C; DBP/C; PGA; SLE; 25-hydroxyvitamin D; Vitamin D binding protein; Spot urine protein to creatinine; Systemic Lupus Erythematosus Disease Activity Index; Juvenile dermatomyositis; Urinary vitamin D binding protein/creatinine ratio; Systemic lupus erythematosus; Estimated glomerular filtration rates; Physician’s Global Assessment; Human; Immunopathology; Connective tissue disease; Pediatrics; Skin disease; Urinary system disease; Dermatomyositis; Autoimmune disease; Striated muscle disease; Vitamin D; Systemic disease; Adolescent; Evolution; Child; Proteinuria
• ISSN: 0022-3476; 1097-6833; 1097-6833
• DOI: 10.1016/j.jpeds.2011.08.011

To evaluate relationships among vitamin D, proteinuria, and disease activity in pediatric systemic lupus erythematosus (SLE) and juvenile dermatomyositis (JDM). Multiple linear regression was used to associate subject-reported race, sunscreen use, and vitamin D intake with physician-assessed disease activity and serum 25-hydroxyvitamin D (25[OH]D) in 58 subjects with pediatric SLE (n = 37) or JDM (n = 21). Serum 25(OH)D was correlated with urinary vitamin D binding protein/creatinine ratio (DBP/C) and other indicators of proteinuria. Serum 25(OH)D levels in subjects with SLE were inversely associated with the natural log of urinary DBP/C (r = −0.63, P < .001) and urine protein to creatinine ratio (r = −0.60, P < .001), with an adjusted mean 10.9-ng/mL (95% CI, 5.1-16.8) decrease in 25(OH)D for those with proteinuria. Excluding subjects with proteinuria, serum 25(OH)D levels were inversely associated with disease activity in JDM, but not in SLE. Overall, 66% of all subjects were taking concurrent corticosteroids, but this was not associated with 25(OH)D levels. Low serum 25(OH)D in patients with SLE is associated with proteinuria and urinary DBP. Vitamin D deficiency is associated with disease activity in patients with JDM and SLE; this relationship in SLE may be confounded by proteinuria.