EFFECTS OF 1,25(OH)₂D₃ (1,25D), 25-OHD₃ (25D) AND DIHYDROTACHYSTEROL (DHT) ON GROWTH VELOCITY (GV) AND QUALITATIVE BONE HISTOLOGY (BH) IN CHILDREN WITH CHRONIC RENAL FAILURE (CRF) AND RENAL OSTEODYSTROPHY (ROD)

Abstract

15 children with a mean age of 8 yrs (2.8-14.9) with CRF (mean GFR 34.8±4.6) and ROD have completed one (n=15) to two (n=9) yrs of 1,25D, 25D or DHT tx (n=5 each), and effects on GV, BH and calcium metabolism were evaluated. Pts were matched by sex, age, initial BH and GFR. GV was defined by standard deviation scores. Overall GV was -1.2±.4 pre-tx and increased to -.2±.3 (p<.025) after 1 year and -1.1±.3 after 2 yrs. Change in GV, analyzed by individual vit D tx was significant (p<.05) only in the DHT subgroup (-1.3±.6 to .1±.4). Pre-tx BH revealed predominant osteitis fibrosa (OF) in 9, predominant osteomalacia (OM) in 1 and both OF and OM in 5. BH normalized after 1 yr in 6; 1 received 1,25D; 3, 25D; and 2, DHT. After 2 yrs, 1 pt's BH reversed to OF while on DHT; 1 pt remained normal while on 1,25D. Improvement in GV was not associated with normalization of BH. iPTH declined overall and in each subgroup but not significantly. Serum Ca, Pi, alk. p'tase, cr and GFR were unchanged during tx. Hypercalcemia occurred in 2 pts receiving 1,25D and 1 receiving DHT; none experienced permanent reduction in GFR. We conclude that early tx of ROD with vit D is associated with significant increase in GV independent of qualitative changes in BH.

Supported in part by Roxane Labs, Hoffman-LaRoche, Upjohn and NIH AM 19278.

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