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Köksoy AY, Görükmez Ö, Dorum S. Clinical significance of hypouricemia in children and adolescents. Pediatr Nephrol 2023; 38:3017-3025. [PMID: 37000195 DOI: 10.1007/s00467-023-05948-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 03/04/2023] [Accepted: 03/06/2023] [Indexed: 04/01/2023]
Abstract
BACKGROUND Although hyperuricemia is a widely studied condition with well-known effects on the kidneys, hypouricemia is usually considered a biochemical abnormality of no clinical significance despite the fact that it can be a sign or major finding of serious metabolic or genetic diseases affecting kidney health. In this study, we aimed to investigate and emphasize the clinical significance of hypouricemia. METHODS Patients were evaluated retrospectively for persistent hypouricemia defined as serum uric acid concentrations of < 2 mg/dL on at least 3 different occasions. According to the blood and urine uric acid (UA) levels, the patients were classified as having hypouricemia due to UA underproduction vs. overexcretion. Demographic, clinical, and genetic characteristics were noted for analysis. RESULTS Fourteen patients (n = 14; M/F 8/6) with persistent hypouricemia were identified. Hypouricemia due to underproduction was the cause of 42.8% of these cases. All of the patients with a uric acid level of 0 mg/dL (n = 4) had hypouricemia due to underproduction. The median serum uric acid level was 0.85 (0-1.6) mg/dL. Isolated hypouricemia and hypouricemia with metabolic acidosis were equally distributed. Among the patients with hypouricemia due to underproduction, the final diagnoses were xanthine dehydrogenase deficiency (n = 5) and alkaptonuria (n = 1). In the overexcretion group, the final diagnoses were nephropathic cystinosis (n = 6), distal renal tubular acidosis (n = 1), and hereditary renal hypouricemia (n = 1). The diagnostic lag was longer for patients with isolated hypouricemia compared to other patients (p = 0.001). CONCLUSIONS Hypouricemia may reflect underlying genetic or metabolic diseases, early diagnosis of which could help preserve kidney function. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Affiliation(s)
- Adem Yasin Köksoy
- Department of Pediatric Nephrology, Van Training and Research Hospital, Van, Turkey.
| | - Özlem Görükmez
- Department of Genetics, Bursa Yüksek İhtisas Training and Research Hospital, Bursa, Turkey
| | - Sevil Dorum
- Department of Metabolism Unit, Bursa Yüksek İhtisas Training and Research Hospital, Bursa, Turkey
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Bako D, Kılavuz S, Yasin Köksoy A, Uzan Tatli Z, Beydogan E. A different approach to cystinosis: ultrasound, doppler, and shear wave elastography findings of thyroid gland. Orphanet J Rare Dis 2023; 18:173. [PMID: 37391835 DOI: 10.1186/s13023-023-02783-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Accepted: 06/18/2023] [Indexed: 07/02/2023] Open
Abstract
BACKGROUND While thyroid dysfunction develops in about 50% of untreated children with cystinosis, there is no data about how the sonography of thyroid tissue appears in this disease. Therefore, the purpose of this study was to assess the sonographic appearance, color doppler findings in this disease and to evaluate how cystine crystal accumulation affect tissue stiffness using shear wave elastography (SWE). METHODS Sixteen children diagnosed with cystinosis and a control group consisting of 34 healthy children were included in this study. B mode ultrasound, color doppler imaging and real-time SWE of thyroid tissue were performed. RESULTS Ultrasound imaging revealed lower echogenicity and diffuse heterogeneous echotexture in 7 of the 16 cystinosis patients. Thyroid gland volumes were lower in cystinosis patients (p 0.005). Doppler ultrasound demonstrated increased flow in 8 patients. On SWE, the thyroid tissue stiffness was established to be lower in patients compared to healthy children (p 0.003). CONCLUSIONS This is the first study evaluating thyroid gland B mode, color doppler ultrasonography, and SWE findings in cystinosis. Our findings indicate that cysteamine treatment still cannot completely prevent the disease infiltration process of thyroid gland. The other important finding-that thyroid tissue stiffness was established to be lower than that of the controls-also demonstrates the ongoing disease infiltration process.
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Affiliation(s)
- Derya Bako
- Department of Pediatric Radiology, Van Regional Training and Research Hospital, Van, Turkey.
| | - Sebile Kılavuz
- Department of Pediatric Pediatric Metabolism and Nutrition, Van Regional Training and Research Hospital, Van, Turkey
| | - Adem Yasin Köksoy
- Department of Pediatric Pediatric Nephrology, Van Regional Training and Research Hospital, Van, Turkey
| | - Zeynep Uzan Tatli
- Department of Pediatric Pediatric Endocrinology, Zeynep Uzan Tatli, Van Regional Training and Research Hospital, Van, Turkey
| | - Engin Beydogan
- Department of Radiology, Van Regional Training and Research Hospital, Van, Turkey
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Bako D, Köksoy AY, Turmak M. Comparison of axial and coronal axis MRI kidney volume measurement in pediatric congenital solitary kidney. Pediatr Nephrol 2022:10.1007/s00467-022-05858-x. [PMID: 36547734 DOI: 10.1007/s00467-022-05858-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Revised: 12/11/2022] [Accepted: 12/12/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Accurate estimation of kidney size and volume in the solitary functioning kidney is crucial because of a higher risk of developing kidney injury. MRI is an accurate method and is suitable for kidney volume measurement. Usually, axial axis images and measurement methods are preferred for kidney volume measurements. However, the anteroposterior diameter of the kidney is smaller than the longitudinal diameter, meaning that imaging in the coronal axis could provide needed information in a shorter time, enabling imaging of younger patients without sedation. Therefore, the purpose of this study was to compare coronal and axial axis kidney volume measurement methods and evaluate intra-observer and inter-observer reliability. METHODS Axial axis T2W and coronal axis FIESTA images of kidneys were obtained with 10 mm slice thickness and no slice gap in pediatric patients with congenital solitary kidneys. Free-hand manual tracing was used to calculate volumes in both methods. Images were analyzed by two operators with different levels of experience. The expert operator computed solitary kidney volume twice in both methods for the intra-observer reliability, while the beginner operator's measurements were used for the inter-observer reliability. RESULTS High intra-observer (0.965 for axial and 0.972 for coronal) and inter-observer reliability were revealed (0.964 for axial and 0.963 for the coronal) for both measurement methods. CONCLUSION The coronal plane volume measurement method, which has a significantly shorter examination and post-processing time, is a highly reproducible and reliable method that can enable volume measurement with MRI in younger children, as the imaging time will be shortened. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Affiliation(s)
- Derya Bako
- Department of Pediatric Radiology, Van Regional Training and Research Hospital, Van Bölge Eğitim Ve Araştırma Hastanesi, Edremit, Van, Turkey.
| | - Adem Yasin Köksoy
- Department of Pediatric Nephrology, Van Regional Training and Research Hospital, Van, Turkey
| | - Mehmet Turmak
- Department of Radiology, Faculty of Medicine, Dicle University, Diyarbakır, Turkey
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Tekin E, Gül ÜŞ, Aydın SK, Köksoy AY. Evaluation of Bone Metabolism in Children Using Antiseizure Drugs: A Single-Center Experience and Review of the Literature. Journal of Pediatric Epilepsy 2022. [DOI: 10.1055/s-0042-1749343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
AbstractThe effect of anti-seizure drugs (ASDs) on bone mineral density (BMD) is a controversial topic. This study investigated the effect of monotherapy and polytherapy drugs separately. Patients with a history of epilepsy treated with the same ASDs for more than 6 months were included in the study. Data regarding patient demographics, biochemical markers related to bone metabolism (calcium, phosphorus, alkaline phosphatase, parathyroid hormone, vitamin D), and BMD with dual-energy X-ray absorptiometry (DXA) were collected and compared. In total, 104 children with epilepsy using valproic acid (VPA), levetiracetam (LEV), carbamazepine (CBZ) alone or in combination and 22 healthy controls were evaluated. The ages of the children (64 boys, 62 girls) ranged between 2 and 17, with a mean of 9.50 ± 4.03 years. BMD or Z-scores did not differ among the monotherapy groups or between them and the polytherapy group. The lowest mean Z-score was in the VPA group but without statistical significance. Alkaline phosphatase levels were significantly higher in the group using CBZ. Calcium levels significantly differed between the groups (p = 0.001). The CBZ and LEV groups had the lowest calcium levels. However, phosphorus and vitamin D measurements did not significantly differ by ASDs used. Unfortunately, low vitamin D levels were evident in all children with epilepsy and even among controls. Physical activity, sun exposure, and calcium intake might be recommended in children treated with ACDs and in combination with additional risk factors monitoring via DXA should be considered. Further studies in a large population are necessary to judge which ASDs are more at risk to reduce bone mineralization than others.
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Affiliation(s)
- Emine Tekin
- Pediatric Neurology Division, Faculty of Medicine, Giresun University, Maternity and Children Hospital, Giresun, Turkey
| | - Ülkü Şiraz Gül
- Department of Pediatric Endocrinology, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Sultan Köker Aydın
- Division of Pediatric Hematology, Department of Pediatrics, Antalya Training and Research Hospital, Antalya, Turkey
| | - Adem Yasin Köksoy
- Division of Pediatric Nephrology, Department of Pediatrics, Van Training and Research Hospital, Van, Turkey
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Dorum S, Erdoğan H, Köksoy AY, Topak A, Görükmez Ö. Clinical features of pediatric renal glucosuria cases due to SLC5A2 gene variants. Pediatr Int 2022; 64:e14948. [PMID: 34380181 DOI: 10.1111/ped.14948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 07/11/2021] [Accepted: 08/10/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Familial renal glycosuria (FRG) is a rare renal tubular disorder characterized by a variable loss of glucose in the urine despite normal blood glucose levels, which is seen in a condition in which other tubular functions are preserved. In this study, the molecular and clinical characteristics of pediatric FRG cases due to SLC5A2 gene variants were defined. METHODS Demographic features, diagnostic tests, and molecular analyses of patients with a diagnosis of FRG cases due to SLC5A2 gene variants were retrospectively analyzed between 2016 and 2019. RESULTS The data of 16 patients who were clinically and genetically diagnosed with FRG in a 4-year period were analyzed. Seven (44%) of the cases were female and 9 (56%) were male. The median age at diagnosis was 6 years old (2 months old to 17 years old). Neuromotor development was found to be appropriate for the age in each case. Systemic blood pressure was evaluated as normal. A homozygous pathogenic variant in the SLC5A2 gene was detected in 14 patients in the genetic examination. A heterozygous variant was detected in one patient. In the other patient, two different heterozygous pathological variants were found in the SLC5A2 gene. CONCLUSIONS It was revealed that growth and development were normal in children with glucosuria due to variations in the SCL5A2 gene. Renal function tests and urinary amino acid excretion were also within normal values. In our case series, the most common genetic variation in the SCL5A2 gene was the A219T (c.655G>A) variant.
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Affiliation(s)
- Sevil Dorum
- Division of Metabolism, Department of Pediatrics, Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey
| | - Hakan Erdoğan
- Division of Nephrology, Department of Pediatrics, Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey
| | - Adem Yasin Köksoy
- Division of Nephrology, Department of Pediatrics, Van Training and Research Hospital, Van, Turkey
| | - Ali Topak
- Department of Genetics, Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey
| | - Özlem Görükmez
- Department of Genetics, Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey
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Köksoy AY. Acute kidney injury, metabolic acidosis, and hypercalcemia with proximal tubular dysfunction-a diagnostic challenge: Questions. Pediatr Nephrol 2021; 36:2703. [PMID: 33730276 DOI: 10.1007/s00467-021-04993-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Accepted: 02/08/2021] [Indexed: 11/27/2022]
Affiliation(s)
- Adem Yasin Köksoy
- Department of Pediatric Nephrology, Van Training and Research Hospital, University of Health Sciences, Süphan Mahallesi Hava Yolu Kavşağı 1. Kilometre Edremit, Van, Turkey.
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Köksoy AY, Görükmez O. Urinary stone and infection does not always mean a 'chicken and egg dilemma': Answers. Pediatr Nephrol 2021; 36:2295-2297. [PMID: 33620572 DOI: 10.1007/s00467-021-04979-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 01/28/2021] [Indexed: 10/22/2022]
Affiliation(s)
- Adem Yasin Köksoy
- Department of Pediatric Nephrology, University of Health Sciences Van Training and Research Hospital, Süphan Mahallesi Hava Yolu Kavşağı 1., Kilometre Edremit, Van, Turkey.
| | - Orhan Görükmez
- Department of Genetics, University of Health Sciences Bursa City Hospital, Bursa, Turkey
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Köksoy AY, Bako D, Şimşek M, Doğan S, Özçiftçi G. An unusual complication of peritoneal dialysis: Questions. Pediatr Nephrol 2021; 36:2059-2060. [PMID: 33768325 DOI: 10.1007/s00467-020-04897-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 12/08/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Adem Yasin Köksoy
- Department of Pediatric Nephrology, University of Health Sciences Van Training and Research Hospital, Süphan Mahallesi Hava Yolu Kavşağı 1. Kilometre, Edremit/Van, Turkey.
| | - Derya Bako
- Department of Pediatric Radiology, University of Health Sciences Van Training and Research Hospital, Van, Turkey
| | - Metin Şimşek
- Department of Pediatric Surgery, University of Health Sciences Van Training and Research Hospital, Van, Turkey
| | - Sida Doğan
- Department of Pediatric Neurosurgery, University of Health Sciences Van Training and Research Hospital, Van, Turkey
| | - Gökçen Özçiftçi
- Department of Pediatric İntensive Care, University of Health Sciences Van Training and Research Hospital, Van, Turkey
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Aydin Köker S, Kömüroğlu AU, Köksoy AY, Şiraz ÜG, Tekin E, Köker A. Evaluation of GLUT1, IGF-2, VEGF, FGF 1, and angiopoietin 2 in infantile hemangioma. Arch Pediatr 2021; 28:296-300. [PMID: 33715934 DOI: 10.1016/j.arcped.2021.02.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 09/22/2020] [Accepted: 02/13/2021] [Indexed: 01/29/2023]
Abstract
INTRODUCTION Infantile hemangioma (IH) is a common vascular tumor in children. It is reported that IHs are associated with immunochemical markers such as vascular endothelial growth factor (VEGF)-A, glucose transporter isoform 1 (GLUT1), and insulin-like growth factor-2 (IGF-2). MATERIAL AND METHODS This cross-sectional study focused on pediatric patients with IH. A total of 46 patients (mean age 14.2±21.9 months) with IH and 45 healthy controls (mean age 21.8±15.08 months) were enrolled. Demographic data, clinical findings, and laboratory parameters were recorded. Blood samples were collected. Serum GLUT1, IGF-2, VEGF-A, fibroblast growth factor 1 (FGF1), and angiopoietin 2 levels were assessed by enzyme-linked immunosorbent assay. RESULTS Serum GLUT1, IGF-2, and VEGF-A levels were significantly higher in patients with IH than in healthy controls (8.80±4.07pg/mL vs. 5.66±4.34pg/mL, 281.10±84.12pg/mL vs. 234.19±75.38pg/mL, 1196.99±389.34pg/mL vs. 996.99±349.16pg/mL, respectively, p=0.026, p=0.030, and p=0.036). Serum GLUT1, IGF-2, and VEGF-A levels in patients with complicated hemangioma were significantly higher than in healthy controls (9.69±3.94pg/mL vs. 5.66±4.34pg/mL, 289.94±83.18pg/mL vs. 234.19±75.38pg/mL, 1276.22±388.24pg/mL vs. 996.99±349.16pg/mL, respectively, p=0.017, p=0.022, and p=0.011). Serum GLUT1, IGF-2, and VEGF-A levels in patients with hemangioma receiving propranolol treatment were significantly higher than in healthy controls. Serum FGF1 levels were higher in patients with IH, complicated hemangioma, and hemangioma receiving propranolol treatment than in healthy controls but the difference was not statistically significantly. CONCLUSION Serum GLUT1, IGF-2, and VEGF-A levels were positively correlated with disease severity in patients with hemangioma, for example, in complicated hemangioma and hemangioma requiring propranolol treatment. However, further research on larger and different age subgroups is warranted to assess these markers.
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Affiliation(s)
- Sultan Aydin Köker
- Department of Pediatric Hematology and Oncology, SBÜ Van Education and Research Hospital, Van, Turkey.
| | | | - Adem Yasin Köksoy
- Department of Pediatrics, SBÜ Van Education and Research Hospital, Van, Turkey
| | - Ülkü Gül Şiraz
- Department of Pediatrics, SBÜ Van Education and Research Hospital, Van, Turkey
| | - Emine Tekin
- Department of Pediatrics, SBÜ Van Education and Research Hospital, Van, Turkey
| | - Alper Köker
- Department of Pediatric Intensive Unit, Hatay State Hospital, Van, Turkey
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Koçak M, Büyükkaragöz B, Çelebi Tayfur A, Çaltik A, Köksoy AY, Çizmeci Z, Günbey S. Causative pathogens and antibiotic resistance in children hospitalized for urinary tract infection. Pediatr Int 2016; 58:467-71. [PMID: 26513232 DOI: 10.1111/ped.12842] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Revised: 08/31/2015] [Accepted: 10/26/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND Urinary tract infections (UTI) are one of the most common bacterial infections in children and a major cause of hospitalization. In this study we investigated the clinical characteristics, causative uropathogens; their antibiotic susceptibility and resistance patterns, treatment modalities and efficacy in children hospitalized for UTI in a tertiary care setting. METHODS Patients hospitalized for an upper UTI between March 2009 and July 2014 were enrolled. The urine culture-antibiogram results and accompanying urinary tract abnormalities were recorded retrospectively. RESULTS A total of 142 patients (104 girls, 73.2%; 38 boys, 26.8%) were enrolled. Mean patient age was 32.6 ± 4.1 months. History of recurrent UTI was present in 45.8% (n = 65), with prior hospitalization in 12.0% (n = 17). Frequency of vesicoureteral reflux was 18.3% (n = 26). Gram-negative enteric microorganisms yielded growth in all culture-positive UTI and the most common microorganism was Escherichia coli (n = 114, 80.3%). Extended spectrum beta-lactamase-producing (ESBL (+)) bacterial strains were detected in 49.3% (n = 70), with third-generation cephalosporin resistance in all and increased duration of hospitalization. CONCLUSIONS The prevalence of UTI with ESBL (+) bacterial strains with multi-drug resistance is increasing in the hospitalized pediatric population, therefore rational use of antibiotics is essential.
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Affiliation(s)
- Mesut Koçak
- Department of Pediatrics, Keçiören Training and Research Hospital, Ankara, Turkey
| | - Bahar Büyükkaragöz
- Department of Pediatric Nephrology, Keçiören Training and Research Hospital, Ankara, Turkey
| | - Asli Çelebi Tayfur
- Department of Pediatric Nephrology, Keçiören Training and Research Hospital, Ankara, Turkey
| | - Aysun Çaltik
- Department of Pediatric Nephrology, Keçiören Training and Research Hospital, Ankara, Turkey
| | - Adem Yasin Köksoy
- Department of Pediatrics, Keçiören Training and Research Hospital, Ankara, Turkey
| | - Zeynep Çizmeci
- Department of Microbiology, Keçiören Training and Research Hospital, Ankara, Turkey
| | - Sacit Günbey
- Department of Pediatrics, Keçiören Training and Research Hospital, Ankara, Turkey
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Gür G, Abaci A, Köksoy AY, Anik A, Catli G, Kişlal FM, Akin KO, Andiran N. Incidence of maternal vitamin D deficiency in a region of Ankara, Turkey: a preliminary study. Turk J Med Sci 2015; 44:616-23. [PMID: 25551932 DOI: 10.3906/sag-1304-107] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND/AIM To evaluate vitamin D levels and risk factors for vitamin D deficiency in healthy newborns and their mothers. MATERIALS AND METHODS Ninety-nine healthy pregnant women (≥ 37 weeks of gestation) were enrolled in the study. Previous history of pregnancies and births, nutritional status, multivitamin supplementation, educational status, type of clothing, and the economic level of the family were recorded. Blood samples were drawn from the mothers and the umbilical cord of the newborns to measure serum 25(OH)D3, calcium, phosphorus, and parathormone levels. RESULTS While vitamin D insufficiency was identified as 62.6% in mothers, it was 58.6% in newborns; on the other hand, the incidence of vitamin D deficiency was 18.2% and 15.2% in mothers and newborns, respectively. Maternal serum 25(OH)D3 concentrations were not significantly related to the number of pregnancies or births, type of clothing, or the nutritional, economical, or educational status of the family (P > 0.05). CONCLUSION These findings suggest that despite a sunny environment, maternal vitamin D deficiency and insufficiency are still important health problems in a developed region of Turkey. Therefore, more effective vitamin D prophylaxis programs are required to prevent vitamin D deficiency in pregnant women and their offspring.
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Affiliation(s)
- Gökçe Gür
- Department of Pediatric Endocrinology, Keçioren Training and Research Hospital, Ankara, Turkey
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