Growth failure in renal disease

Area of Science:

• Pediatric Nephrology
• Endocrinology
• Growth and Development

Background:

• Children with chronic renal failure (CRF) exhibit significant height loss, primarily during infancy and puberty.
• Growth impairment in CRF stems from malnutrition, metabolic disturbances in early life, and hormonal dysregulation, including growth hormone (GH) resistance, during puberty.

Purpose of the Study:

• To investigate the factors contributing to growth impairment in children with CRF.
• To evaluate the efficacy of recombinant human growth hormone (rhGH) therapy in improving growth in pediatric CRF patients.

Main Methods:

• Analysis of growth patterns during infancy and puberty in CRF patients.
• Assessment of hormonal profiles, including GH secretion, half-life, and insulin-like growth factor (IGF) system components.
• Evaluation of rhGH treatment outcomes, including growth velocity and height changes.

Main Results:

• CRF leads to delayed puberty, reduced growth velocity, and diminished peak height velocity.
• GH resistance is evident in CRF, characterized by normal GH secretion but prolonged half-life and reduced IGF-I bioactivity due to altered IGF binding proteins (IGFBPs).
• rhGH therapy (1 IU/kg/week) significantly improves growth velocity, with a mean height increase of +1.5 SDS in prepubertal children over two years.

Conclusions:

• Growth impairment in pediatric CRF is multifactorial, involving nutritional, metabolic, and endocrine factors.
• rhGH treatment is effective in enhancing growth velocity in children with CRF, irrespective of disease stage.
• Further research is needed to determine the long-term effects of rhGH on final height and its efficacy during puberty in CRF patients.