Growth in children with chronic renal failure and after renal transplantation

Area of Science:

• Pediatric Nephrology
• Endocrinology
• Growth Disorders

Background:

• Growth retardation is a significant complication in pediatric chronic renal failure (CRF) and post-kidney transplantation.
• Hormonal imbalances, including growth hormone (hGH) and parathormone (PTH), are implicated in growth impairment in these children.

Purpose of the Study:

• To investigate the relationship between height, glomerular filtration rate (GFR), and hormonal alterations (hGH, PTH) in children with CRF undergoing hemodialysis (HD).
• To assess the impact of a functioning kidney graft on these growth parameters and hormonal levels compared to CRF patients on HD and healthy controls.

Main Methods:

• A comparative study involving 36 children on regular HD, 32 pediatric transplant recipients, and 20 healthy controls.
• Growth parameters (height standard deviation scores - Ht SDS) and serum levels of hGH and PTH were measured at baseline and after one year.
• Statistical analysis included non-parametric Kendall's correlation to evaluate relationships between variables.

Main Results:

• Children with CRF and functioning grafts exhibited significantly higher serum hGH and PTH levels than controls.
• CRF patients on HD showed significantly higher hGH and PTH levels compared to those with functioning grafts.
• Negative correlations were observed between dialysis duration, serum creatinine, and PTH; positive correlations were found for serum calcium and GFR.

Conclusions:

• Pediatric CRF and kidney transplantation are associated with significant alterations in hGH and PTH regulation.
• The degree of hormonal derangement appears greater in children with CRF on HD compared to those with a functioning graft.
• GFR and serum calcium levels correlate positively with growth parameters, while dialysis duration and creatinine correlate negatively, highlighting the complex interplay of factors affecting growth in these patients.