Efficacy Of Zinc Supplementation In Maintaining Sustained Remission In Children With Steroid-Sensitive Nephrotic Syndrome
DOI:
https://doi.org/10.36283/ziun-pjmd15-1/011Keywords:
Nephrotic Syndrome, Prednisolone, Proteinuria, Relapse, ZincAbstract
Background: Nephrotic syndrome (NS) is one of the most prevalent primary glomerular diseases affecting children, causing significant morbidity. This study was performed to determine the efficacy of zinc supplementation in maintaining sustained remission (SR) in children with steroid sensitive nephrotic syndrome (SSNS).
Methods: This randomized controlled trial was conducted at the Pediatric Medicine Outpatient Department, Nishtar Hospital, Multan, from July 2024 to May 2025. A total of 192 children aged 2–12 years with frequently relapsing were enrolled through random sampling, and randomly assigned to receive either zinc supplementation plus standard therapy or standard therapy alone for six months. Zinc was given as 5 mg (<4 years) or 10 mg (>4 years) daily, and SR was assessed. Data were analyzed using SPSS v26.0, with chi-square, and independent sample t-test applied, taking p<0.05 was considered significant.
Results: In a total of 192 children, 117 (60.9%) were male. The mean age, and duration of disease was 7.36 ± 2.02 years, and 2.03±0.61 years, respectively. The mean number of relapses was 2.15±0.41. Overall, the efficacy was noted in 74 (38.5%) children. The efficacy was seen in 46 (47.9%) children in Zinc group while no Zinc group showed efficacy in 28 (29.2%) children (p = 0.011). Efficacy was found to have significant association with socio-economic status in zinc treated group (p=0.044).
Conclusion; This study support the use of Zinc supplementation in pediatric SSNS, exhibiting significant efficacy in imparting remission of relapses.
Keywords: Nephrotic syndrome, prednisolone, proteinuria, relapse, zinc.
Trial Registration: NCT06860620 (clinicaltrials.gov)
References
1. Mahamat AG, Djidita HY, Mahamat HA, Charfadine S, Amne AS, Khadidja AA, et al. Idiopathic Nephrotic Syndrome in Children in Chad: Epidemiology and Clinical Outcomes. J Clin Med. 2023 Dec;12(24):7626. doi: 10.3390/jcm12247626
2. Londeree J, McCracken CE, Greenbaum LA, Anderson EJ, Plantinga LC, Gillespie SE, et al. Estimation of childhood nephrotic syndrome incidence: data from the atlanta metropolitan statistical area and meta-analysis of worldwide cases. J Nephrol. 2022 Jul;35(2):575-583. doi: 10.1007/s40620-021-01108-9
3. Chanchlani R, Parekh RS. Ethnic Differences in Childhood Nephrotic Syndrome. Front Pediatr. 2016 Apr; 4:39. doi: 10.3389/fped.2016.00039
4. Hussain A. Childhood nephrotic syndrome in Pakistan: clinical features and response to steroid therapy. Pak J Med Res. Jan;1997;36(1):92-94.
5. Hahn D, Samuel SM, Willis NS, Craig JC, Hobson EM. Corticosteroid therapy for nephrotic syndrome in children. Cochrane Database Syst Rev. 2020 Aug;2020(8):CD001533. doi: 10.1002/14651858.CD001533.pub6
6. Trautmann A, Boyer O, Hodson E, Bagga A, Gipson DS, Samuel S, et al. IPNA clinical practice recommendations for the diagnosis and management of children with steroid-sensitive nephrotic syndrome. Pediatr Nephrol. 2023 Aug;38(3):877-919. doi: 10.1007/s00467-022-05739-3
7. Campbell RE, Thurman JM. The Immune System and Idiopathic Nephrotic Syndrome. Clin J Am Soc Nephrol. 2022 Dec;17(12):1823-1834. doi: 10.2215/CJN.07180622
8. Bhatt GC, Jain S, Das RR. Zinc supplementation as an adjunct to standard therapy in childhood nephrotic syndrome - a systematic review. World J Clin Pediatr. 2016 Nov;5(4):383-390. doi: 10.5409/wjcp.v5.i4.383
9. Arun S, Bhatnagar S, Menon S, Saini S, Hari P, Bagga A. Efficacy of zinc supplements in reducing relapses in steroid-sensitive nephrotic syndrome. Pediatr Nephrol. 2009 Aug;24(8):1583-6. doi: 10.1007/s00467-009-1170-5
10. Sherali AR, Moorani KN, Chishty SH, Khan SI. Zinc supplement in reduction of relapses in children with steroid sensitive nephrotic syndrome. J Coll Physicians Surg Pak. 2014 Feb;24(2):110-3.
11. Zubair A, Moorani KN. A High Prevalence Of Vitamin D Deficiency In Children With Steroid Sensitive Nephrotic Syndrome. Pak J Kidney Dis. 2017 Jul-Sep;1(3):14-20. Available from: https://pjkd.com.pk/index.php/pjkd/article/view/41
12. Jabeen I, Khurshid A, Aziz T. Frequency of relapse of steroid sensitive nephrotic syndrome in children during the first year after completion of six months steroid therapy. Professional Med J. 2020 Mar; 27(3):558-562. doi: 10.29309/TPMJ/2020.27.3.3571
13. Mbanefo NR, Uwaezuoke SN, Eneh CI, Odimegwu CL, Chikani UN, Muoneke UV, et al. Can Oral Zinc Supplementation Reduce Relapses in Childhood Steroid-Sensitive Nephrotic Syndrome? A Systematic Review. Int J Nephrol Renovasc Dis. 2023 Apr;16:143-153. doi: 10.2147/IJNRD.S403699
14. Ibrahim MAAF, Aziz WSDA, El-Sharawi MN. Zinc as a Supplement in Reduction of Relapses in Children with Nephrotic Syndrome. J Egypt Soc Pediatr Nephrol Transplant. 2022 Feb;17(2):23-30. Available from: https://geget.journals.ekb.eg/article_287730_0c2f4ee013b699b3f14bf0c241c46642.pdf
15. Kumar D, Arya P, Sharma IK, Singh MV. Effect of zinc therapy in remission of pediatric nephrotic syndrome. Int J Contemp Pediatr. 2017 Jun;4(6):2036. doi: 10.18203/2349-3291.ijcp20174726
16. Hashmi F, Ghazi SS, Mumtaz H, Amjad M, Zaman N, Ahmad S. Role of Zinc Supplementation in Comparison to B Complex for Reducing the Frequency of Sustained Remission in Steroid-Sensitive Nephrotic Syndrome Among Pediatric Age Group. Ann Pak Inst Med Sci. 2021 July-Sep;17(3):236-240. doi.10.48036/apims.v17i3.408
17. Jin D, Wei X, He Y, Zhong L, Lu H, Lan J, et al. The nutritional roles of zinc for immune system and COVID-19 patients. Front Nutr. 2024 Apr;11:1385591. doi: 10.3389/fnut.2024.1385591
18. Prasad AS. Effects of zinc deficiency on Th1 and Th2 cytokine shifts. J Infect Dis. 2000 Sep;182(Suppl 1):S62-8. doi: 10.1086/315916
19. Taherahmadi H , Yousefichaijan P, Rezagholizamenjany M, Rafiei M , Norozi S . Serum Zinc Level in Recurrent Nephrotic Syndrome. Nephro-Urol Mon. 2019 Aug;11(4):e96628. doi: 10.5812/numonthly.96628
20. Antunes MMO, Penido MGMG, Campos AMFS, Veloso S, Pinheiro B. Pharmacological and Non-Pharmacological Approaches to the Treatment of Steroid-Sensitive Pediatric Nephrotic Syndrome: A Review. Int J Clin Nephrol. 2022 Sep;1(2):1-12. doi: 10.37579/2834-5142/005
21. Lella G, Pecoraro L, Benetti E, Arnone OC, Piacentini G, Brugnara M, et al. Nutritional Management of Idiopathic Nephrotic Syndrome in Pediatric Age. Med Sci (Basel). 2023 Jul;11(3):47. doi: 10.3390/medsci11030047
22. Jechel E, Nedelcu AH, Dragan F, Lupu VV, Starcea IM, Mocanu A, et al. Nutritional management of pediatric nephrotic syndrome regarding oxidative stress and antioxidant balance. Front Immunol. 2025 May;16:1542735. doi: 10.3389/fimmu.2025.1542735
23. Uwaezuoke SN. Steroid-sensitive nephrotic syndrome in children: triggers of relapse and evolving hypotheses on pathogenesis. Ital J Pediatr. 2015 Mar;41:19. doi: 10.1186/s13052-015-0123-9
24. Lupu A, Starcea IM, Jechel E, Gavrilovici C, Mocanu A, Streanga V, et al. The Role of Zinc in the Evolutionary Pattern of Pediatric Nephrotic Syndrome: A Meta-Analysis. Nutr Rev. 2025 Jun:nuaf106 (Epub ahead of print). doi: 10.1093/nutrit/nuaf106
25. Padoan F, Piccoli E, Pietrobelli A, Moreno LA, Piacentini G, Pecoraro L. The Role of Zinc in Developed Countries in Pediatric Patients: A 360-Degree View. Biomolecules. 2024 Jun;14(6):718. doi: 10.3390/biom14060718
Downloads
Published
Issue
Section
License
Copyright (c) 2026 Pakistan Journal of Medicine and Dentistry
This work is licensed under a Creative Commons Attribution 4.0 International License.
This is an open-access article distributed under the terms of the CreativeCommons Attribution License (CC BY) 4.0 https://creativecommons.org/licenses/by/4.0/
Metrics
How to Cite
