Related Experiment Video
Updated: Aug 15, 2026
5/6th Nephrectomy in Combination with High Salt Diet and Nitric Oxide Synthase Inhibition to Induce Chronic Kidney Disease in the Lewis Rat
Published on: July 3, 2013
Conservative treatment for chronic renal failure from birth: a 3-year follow-up study
M Van Dyck1, N Bilem, W Proesmans
1Renal Unit, Department of Pediatrics, University Hospital, University of Leuven, Herestraat 49, B-3000 Leuven, Belgium.
Insights
Conservative management of pediatric chronic renal failure (CRF) led to initial growth deceleration but stable anthropometrics thereafter. Patients showed improved height velocity compared to historical controls, indicating effective conservative treatment for early-stage CRF.
Area of Science:
- Pediatric Nephrology
- Growth and Development
- Chronic Renal Failure Management
Background:
- Pediatric chronic renal failure (CRF) diagnosed in infancy presents unique challenges for growth and development.
- Conservative management strategies are crucial for patients not yet requiring renal replacement therapy (RRT).
- Understanding long-term growth outcomes in conservatively managed pediatric CRF is essential.
Purpose of the Study:
- To evaluate the growth parameters (length, weight, head circumference) and height velocity in infants with CRF treated conservatively.
- To compare the growth outcomes of these patients with historical data from a larger CRF cohort.
- To assess biochemical markers and the incidence of renal osteodystrophy in this cohort.
Main Methods:
- Longitudinal study of 15 children with CRF (serum creatinine ≥ 1 mg/dl in the 1st year of life) over 3 years.
- Conservative treatment included diet, sodium bicarbonate, sodium chloride, calcium, and vitamin D; erythropoietin was used in 5 patients.
- Anthropometric measurements (length, weight, head circumference) and height velocity were analyzed; biochemical markers and kidney length were also assessed.
Main Results:
- All anthropometric variables showed an initial drop in the first 3 months, followed by stabilization.
- Mean standard deviation scores at 3 years were -1.96 (length), -1.37 (weight), and -1.07 (head circumference).
- Height velocity in the 1st and 2nd years (22.2 and 10.9 cm/year) was significantly better than historical controls (12.3 and 8.3 cm/year).
- Median serum calcium, phosphate, parathyroid hormone, and albumin remained within normal limits.
- One patient developed therapy-resistant hyperparathyroidism, and 4 showed signs of renal osteodystrophy.
- Kidney length showed minimal growth.
Conclusions:
- Conservative management of early-stage pediatric CRF can lead to stable anthropometric parameters after an initial deceleration.
- This management approach resulted in improved height velocity compared to previously reported cohorts.
- While generally effective, careful monitoring for complications like hyperparathyroidism and renal osteodystrophy remains necessary.
Abstract:
Fifteen children with chronic renal failure from early infancy who did not require renal replacement therapy were followed for 3 years. Chronic renal failure was defined as a serum creatinine at or above 1 mg/dl for the entire 1st year of life. These patients were treated conservatively with diet and supplements of sodium bicarbonate and sodium chloride, calcium and vitamin D. Erythropoietin was given to 5 patients. Neither nasogastric nor gastrostomy tube feeding was used, and none of the patients received recombinant human growth hormone. We analyzed length, weight, and head circumference at 3, 12, 24, and 36 months of age. All three variables displayed a significant drop in the first 3 months, but remained stable for the whole observation period thereafter. At the age of 3 years, the patients' mean values of length, weight, and head circumference standard deviation score were -1.96, -1.37, and -1.07, respectively. Height velocity during the 1st, 2nd, and 3rd year was 22.2, 10.9, and 7.6 cm per year, respectively. The first two figures and the cumulative height velocity are significantly better than those from a large cohort of chronic renal failure patients collected by the European Study Group for Nutritional Treatment of Chronic Renal Failure in Childhood; here the corresponding figures of height velocity were 12.3, 8.3, and 7.6 cm per year. Median serum calcium, phosphate, parathyroid hormone, and albumin levels remained within normal limits for the entire study period. Therapy-resistant hyperparathyroidism occurred in 1 patient and radiological signs of renal osteodystrophy in 4 patients. Kidney length, as measured by ultrasonography, showed almost no growth.
Related Concept Videos
01:30Continuous Renal Replacement Therapy
01:16Kidney Transplant III: Nursing Management
01:29Acute Kidney Injury III: Clinical Manifestations
01:30Acute Kidney Injury IV: Diagnostic Studies and Prevention
01:28Chronic Kidney Disease III: Interprofessional Care
01:18Chronic Kidney Disease IV: Nursing Management