The relation between prevalence of masked hypertension and vitamin D in patients with renal scarring

Objective: The aim of this study was to determine the prevalence of masked hypertension in patients with renal scars, and to investigate the relationship between vitamin D metabolism and VDR gene polymorphism. Materials and Methods: This cross-sectional prospective study was conducted between May 2015 and May 2017 for 40 patients between the ages of 8-18 years who were admitted to Manisa Celal Bayar University Medical Faculty Hospital Pediatric Nephrology clinic and renal scarring. The control group consisted of 40 patients who were admitted to Manisa Celal Bayar University Medical Faculty Hospital Pediatrics Polyclinic for the control of age, gender and socioeconomic level and who were compatible with the patient group and who had no additional disease. In the case group, renal scar was performed according to static cortical renal scintigraphy (DMSA) using technetium-99m-dimercaptosuccinic acid. Clinical blood pressure was measured as 24 hours on ambulatory blood pressure monitor (ABPM) and at least four times on two different days. The mean blood pressure was above 95 percentile according to age, sex and color and blood pressure More than 25% was interpreted as hypertension. Non-dipping (a decrease of less than 10% at nighttime) was considered a factor predisposing to hypertension. Carotid artery intima media thickness (cIMT), an early vascular indicator of target organ damage in hypertension, was measured by carotid doppler ultrasonography in each case. Serum 25 levels of hydroxy vitamin D and fok-1 D vitamin receptor gene polymorphism were studied by taking blood from each participating child at one time. Glomerular filtration rate (GFR-ml / min / 1.73 m²) was calculated by evaluating protein level (mg / m2 / h) and urea and creatinine clearance in 24-hour urine. Data were analyzed using SPSS-18 statistical package program. Findings: A total of 78 patients were enrolled in the study, 40 patients and 38 control groups. The prevalence of masked hypertension was 5% in the patient group. There was no hypertensive case detected in the control group. Nondipping was found in 16 patients in the patient group and 6 cases in the control group, and this finding was statistically significant between both groups (p = 0.018). No significant difference was found between serum vitamin D levels in the patient and control group. When the renal scar was staged according to the severity of the scar, the serum D vitamin level decreased (p = 0.03). When VDR gene polymorphism, proteinuria and GFR levels were examined, no difference was found between the patients without renal scarring and those without hypertensive scarring. When cIMT measurements were assessed, participants with hypertension were significantly higher than those without left carotid cIMT (mean: 0.42 ± 0.09 mm) (mean: 0.40 ± 0.04 mm) (p = 0.029). There was no significant difference between the two groups in right carotid cIMT measurements. Conclusion: If renal scar and D vitamine deficiency relationship are detected, vitamin D support may be in the treatment of patients with renal scars. With early vitamin D supplementation, the progression of this disease can be prevented. Early recognition and treatment of blood pressure elevations that may escape from the eye by clinical measurements may also reduce the risk and duration of renal failure development in these patients over the years. We think that it is important to make this relationship clear by studies to be done in larger patient groups.