Paediatrica Indonesiana

VOLUME 50 November ‡ NUMBER 6

Original Article

Relationship between ionized calcium and serum

albumin level in children with idiopathic nephrotic
syndrome
Viola Irene Winata, Dida Akhmad Gurnida, Nanan Sekarwana

N
Abstract HSKURWLFV\QGURPH16LVDSDWKRORJLFDO
Background  1HSKURWLF V\QGURPH 16 SDWLHQWV IUHTXHQWO\
have abnormalities in calcium metabolism that manifest as
hypocalcemia and reduced intestinal absorption of calcium.
Hypocalcemia is initially attributed to hypoalbuminemia but it may
also relate to a low level of ionized calcium. The ionized calcium
level depends on the severity and duration of proteinuria.
Objective To assess the relationship between ionized calcium and
VHUXPDOEXPLQOHYHOLQLGLRSDWKLF16FKLOGUHQ
Methods An analytical study with cross-sectional design was
DSSOLHGWR16DQGKHDOWK\FKLOGUHQEHWZHHQ\HDUVROGLQWKH
&KLOG+HDOWK'HSDUWPHQWRI+DVDQ6DGLNLQ+RVSLWDO%DQGXQJ
IURP'HFHPEHUWR$SULO,RQL]HGFDOFLXPZDVH[DPLQHG
entity characterized by massive proteinuria
and hypoalbuminemia. It is a chronic
disease indicated by remission and relapse.
Its prognostic varies according to histopathology and
the clinical symptoms. Ponco UHSRUWHG  16
cases during 4.5 years in the Child Health Department
RI+DVDQ6DGLNLQ*HQHUDO+RVSLWDO%DQGXQJZLWKDQ
DYHUDJHDJHRI\HDUVPRQWKV
One of the proteins that lost from the body
into urine along with albumin is vitamin D binding
E\&DDQDO\]HU$9/ZLWKLRQVHOHFWLYHHOHFWURGHV,6(
methods.
Results $WRWDORIVXEMHFWVZHUHUHFUXLWHGFRQVLVWRI16DQG
KHDOWK\FKLOGUHQ7KHPHDQLRQL]HGFDOFLXPDQGVHUXPDOEXPLQ
protein. Calcium absorption in intestine depends on
vitamin D.+\SRFDOFHPLDLQ16LVLQLWLDOO\DWWULEXWHG
to hypoalbuminemia but many also have low ionized
calcium levels.4 Total calcium in human body is in
OHYHOLQ16FKLOGUHQZDV6'PJG/DQG6'
JG/UHVSHFWLYHO\6WDWLVWLFDOGLIIHUHQFHEHWZHHQLRQL]HGFDOFLXP WKUHHIRUPVZKLFKLVLRQL]HGERXQGWRSURWHLQDQG
OHYHO LQ 16 DQG LQ KHDOWK\ FKLOGUHQ ZDV VLJQLILFDQW 3
Pearson correlation test between ionized calcium and serum
albumin was significant (P<0.05) with correlation coefficient (r)
:HIRXQGWKHIROORZLQJHTXDWLRQWRHVWLPDWHLRQL]HGFDOFLXP
(Ɛ) based on the serum albumin level (x): Ɛ [
Conclusion There is a moderately positive linear relationship
EHWZHHQLRQL]HGFDOFLXPDQGVHUXPDOEXPLQOHYHOLQ16FKLOGUHQ
[Paediatr Indones. 2010;50:361-4].
Keywords: nephrotic syndrome, ionized calcium,
serum albumin
FRPSOH[HGZLWKDQLRQV7KH\DUHLQHTXLOLEULXPHDFK
other. Only the ionized calcium has been reported to
be physiologically active. If the ionized calcium level
GHFOLQHVEHORZQRUPDOQHUYRXVV\VWHPSURJUHVVLYHO\
becomes more sensitive and provokes clinical
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8QLYHUVLW\+DVDQ6DGLNLQ*HQHUDO+RVSLWDO%DQGXQJ,QGRQHVLD
Reprint requests to 9LROD ,UHQH :LQDWD 0' 'HSDUWPHQW RI &KLOG
+HDOWK0HGLFDO6FKRRO3DGMDGMDUDQ8QLYHUVLW\+DVDQ6DGLNLQ*HQHUDO
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)D[(PDLOviola_irene@yahoo.com
Paediatr Indones, Vol. 50, No. 6, November 2010‡361
 Viola Irene Winata et al: Ionized calcium and serum albumin level in idiopathic nephrotic syndrome

symptoms.5 and linear regression was performed to evaluate the

A previous study showed that there was a
negative and weak relationship between ionized
FDOFLXPDQGVHUXPDOEXPLQOHYHOLQ16FKLOGUHQ6 The
purpose of this study is to evaluate that relationship
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relationship between ionized calcium and serum
DOEXPLQ OHYHO LQ 16 FKLOGUHQ 8QSDLUHG 7WHVW ZDV
used to compare the mean difference between
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children. The statistical analysis was performed using
Methods
An analytical study with cross-sectional design had
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 LQ WKH &KLOG +HDOWK 'HSDUWPHQW RI +DVDQ
6DGLNLQ*HQHUDO+RVSLWDO%DQGXQJ6XEMHFWVFRQVLVWHG
RI16FKLOGUHQDQGKHDOWK\FKLOGUHQ,QFOXVLRQFULWHULD
IRU 16 FKLOGUHQ ZHUH DFWLYH 16 ILUVW GLDJQRVH RU
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Results
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healthy children) were recruited to this study. The
FKDUDFWHULVWLFVRIWKHVXEMHFWVDUHVKRZQLQTable 1.
7KHPHDQLRQL]HGFDOFLXPLQ16FKLOGUHQ
UHODSVHDJHGEHWZHHQ\HDUV+HDOWK\FKLOGUHQ 6'PJG/ZDVORZHUWKDQWKDWLQKHDOWK\FKLGUHQ
ZLWK WKH VDPH DJH DQG VH[ DV 16 FKLOGUHQ ZHUH 6'PJG/ZLWKDPHDQGLIIHUHQFHRI
recruited as a control group. The criteria of healthy PJG/&,WR
ZDVEDVHGRQWRWKH,QGRQHVLDQODZZKLFKLVVWDWH The mean ionized calcium and serum albumin
RI KHDOWK LQFOXGLQJ WKH ERG\ SK\VLFDO VSLULWXDO OHYHO LQ 16 FKLOGUHQ ZHUH  6'  PJG/
PHQWDODQGVRFLDODQGQRWOLPLWHGWRDVWDWHIUHH DQG  6'  JG/ UHVSHFWLYHO\ 7KHUH ZDV
IURP GLVHDVH GLVDELOLW\ DQG ZHDNQHVV ([FOXVLRQ
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between ionized calcium and serum albumin level
LQ 16 FKLOGUHQ %DVHG RQ WKH FDOFXODWLRQ RI OLQHDU
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calcium level (Ɛ) based on the serum albumin level
of severe malnutrition.. [WKDWZDVƐ [ZLWKDGMXVWHGUVTXDUH
History taking and physical examination were DVVKRZQLQFigure 1.
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%ORRGZDVWDNHQIURPERWKKHDOWK\DQG16FKLOGUHQ
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serum glutamic Table 1. Characteristics of subjects
S\UXYLF WUDQVDPLQDVH 6*37 ZHUH PHDVXUHG NS children Healthy children
n=17 n=17
LQ 16 FKLOGUHQ 7KH KHDOWK\ FKLOGUHQ ZHUH RQO\
Sex
performed ionized calcium level. Ionized calcium was Male (%) 11(64.7) 11 (64.7)
examined by CaDQDO\]HU$9/PRGHOV7 in the Weight (kg)
ODERUDWRU\RI&OLQLFDO3DWKRORJ\RIWKH+DVDQ6DGLNLQ Mean (SD) 16.84 (5.09) 20.59 (8.124)
Hospital. Laboratory method used for measuring the Median 17 18
FRQFHQWUDWLRQRILRQL]HGFDOFLXPZDV,6(7 Range 10-27 12-44
Written informed consents were obtained Height (cm)
Mean (SD) 103.29 (15.6) 107.53 (17.745)
from the parent of each patient before participating
Median 102 104
in this study. This study had been approved by Range 79-133 83-146
the Ethical Committee of Medical Faculty of Nutritional status
3DGMDGMDUDQ 8QLYHUVLW\ +DVDQ 6DGLNLQ *HQHUDO Good (%) 11 (64.7) 17 (100)
+RVSLWDO%DQGXQJ Mild malnutrition (%) 6 (35.5) 0
6WDWLVWLFDO DQDO\VLV XVLQJ 3HDUVRQ FRUUHODWLRQ SD= standard deviation

362‡Paediatr Indones, Vol. 50, No. 6, November 2010

 Viola Irene Winata et al: Ionized calcium and serum albumin level in idiopathic nephrotic syndrome

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Choi et al6 found a weak positive relationship between
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Amballi et al  reported that in a state of
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clinical manifestations were rare. Garniasih found
an association between serum albumin level and total
Ɛ [ serum calcium in children. The total serum calcium
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$GMXVWHGU 
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total serum calcium level decreased then the ionized
,RQL]HGFDOFLXPPJG/ calcium level also decreased.,QWKLVVWXG\ZH
Figure 1. Relationship between ionized calcium lev-
el and serum albumin level in nephrotic syndrome
children
Discussion
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found a positive relationship between ionized calcium
level and serum albumin. This means that the lower
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be. Previous research conducted by Choi et al6 showed
a weak negative correlation between serum albumin
and ionized calcium level. Choi et al6 also found a
very weak positive relationship between the duration
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that the ionized calcium level is determined by the
ZLWKDPHDQRI6'JG/7KHGHFUHDVHG severity of proteinuria. Other factors that may affect
DOEXPLQ OHYHO LQ 16 FKLOGUHQ LV GXH WR D GDPDJHG ionized calcium level are the duration of proteinuria
glomerular filtration membrane in the renal cortex. before being treated and the patients’ diagnosis (first
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nature of size-selectivity in the glomerular capillary
epithelium becomes disrupted.6HNDUZDQD showed
the importance of hyperlipidemia in atherosclerosis
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used as basic to predict long term prognosis in patients
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This study also showed that the ionized calcium
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statistical correlation with ionized calcium level in
this study.
Ionized calcium is an important physiological
component and its levels are not influenced by
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from total serum calcium is important for optimal
clinical decision making.5 When the concentration
of ionized calcium in extra-cellular fluid falls below
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WR)LVFKEDFK·VUDQJHIRUFKLOGUHQDJHG\HDUV DQG PXVFOH FUDPSV WHWDQL LQ WKH IDFH EDFN DQG
 PJG/. This may be due to the decrease of
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during the course of the disease associated with
timing of proteinuria. Hooft et al observed that
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having proteinuria for more than two months. In this
legs.,RQL]HGFDOFLXPOHYHOOHVVWKDQPJG/FDQ
cause life-threatening complication.
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calcium (Ɛ) as the dependent variable based on serum
albumin (x) as the independent variable. The resulting
Paediatr Indones, Vol. 50, No. 6, November 2010‡363
 Viola Irene Winata et al: Ionized calcium and serum albumin level in idiopathic nephrotic syndrome
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the scope of this study.
The limitation of this study is that the examination
of the ionized calcium level was done only once upon
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determine its severity.
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linear relationship between ionized calcium and serum
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calcium in serum with ion-selective electrodes: a mature
technology that can meet the daily service needs. Clin Chem.

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of dietary habits on calcium level in nephrotic patients of
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proteinuria syndrome and mechanism of proteinuria. N engl
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of nephrotic syndrome in children and correlation of
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