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Growth retardation in children with chronic renal insufficiency

B A Warady1

  • 1Children's Mercy Hospital, 2401 Gillham Road, Kansas City, MO 64108, USA.

Journal of the American Society of Nephrology : JASN
|July 11, 2001
PubMed

Insights

Children with chronic renal insufficiency (CRI) experience growth retardation due to impaired growth hormone/insulin-like growth factor (IGF) axis function. Early intervention before end-stage renal disease is crucial for preventing severe height deficits in these pediatric patients.

Area of Science:

  • Pediatric Nephrology
  • Endocrinology
  • Growth Disorders

Background:

  • Progressive growth retardation is a common complication in children with chronic renal insufficiency (CRI).
  • This condition often leads to significantly reduced adult height, with SD scores of -1.88 or worse.
  • Disruptions in the growth hormone/insulin-like growth factor (IGF) axis are primary contributors to subnormal height velocity in CRI.

Purpose of the Study:

  • To investigate the role of the growth hormone/insulin-like growth factor (IGF) axis in pediatric growth retardation associated with chronic renal insufficiency (CRI).
  • To explore the impact of IGF binding proteins on IGF bioactivity and linear growth.
  • To evaluate the potential of recombinant human growth hormone therapy and identify optimal intervention timing.

Main Methods:

  • Analysis of growth hormone/insulin-like growth factor (IGF) axis components, including IGF binding proteins in serum.
  • Assessment of IGF bioactivity and its correlation with linear growth parameters.
  • Review of treatment outcomes with recombinant human growth hormone in pediatric CRI patients.

Main Results:

  • Elevated levels of specific IGF binding proteins in the 35-kD serum fractions were found to depress IGF bioactivity, impairing linear growth.
  • Recombinant human growth hormone therapy showed potential to increase IGF levels and restore bioactivity, leading to improved height velocity.
  • Despite treatment, over one-third of pediatric CRI patients remain severely growth-retarded, indicating limitations in current therapeutic approaches.

Conclusions:

  • Disorders of the growth hormone/insulin-like growth factor (IGF) axis, particularly involving IGF binding proteins, are central to growth retardation in pediatric chronic renal insufficiency (CRI).
  • While recombinant human growth hormone offers some benefit, its effectiveness is limited, and a significant portion of patients experience severe growth deficits.
  • Preventative or corrective strategies for growth retardation in CRI should be implemented during the pre-end-stage renal disease period for optimal outcomes.

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