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Chronic renal failure and growth
1Evelina Children's Hospital, United Medical School, London.
Insights
Intensive management of chronic renal failure aided catch-up growth in children under two. However, growth remained poor for most children over two, regardless of kidney function.
Area of Science:
- Pediatric Nephrology
- Growth and Development
- Chronic Kidney Disease
Background:
- Chronic renal failure (CRF) significantly impacts growth in children.
- Many prepubertal children with CRF exhibit growth failure, often below two standard deviations from the mean height.
- Early intervention is crucial for managing growth in pediatric CRF.
Purpose of the Study:
- To assess the impact of intensive medical management on growth in prepubertal children with chronic renal failure.
- To identify factors influencing growth outcomes in this pediatric population.
- To evaluate the relationship between glomerular filtration rate and growth in children with CRF.
Main Methods:
- Longitudinal study of 38 prepubertal children with chronic renal failure.
- Assessment of growth parameters (height) and glomerular filtration rate (GFR) over a mean follow-up of 2.3 years.
- Analysis of growth catch-up based on age at presentation and correlation with GFR.
Main Results:
- Half of children presenting before age two showed catch-up growth after intensive management.
- Children presenting after age two experienced only slow growth improvement.
- No significant correlation was found between GFR and growth, with a persistent group showing poor growth, often linked to low birth weight and dysplastic kidneys.
Conclusions:
- Early intervention (before age two) in pediatric chronic renal failure can facilitate catch-up growth.
- Growth outcomes in pediatric CRF are complex and not solely dependent on GFR.
- Factors like birth weight and kidney etiology play a role in persistent growth failure.
Abstract:
Growth was assessed in 38 prepubertal children with chronic renal failure for a mean (range) of 2.3 (1-4) years. At first clinic visit their mean (range) glomerular filtration rate was 17 (7-35) ml/min/1.73 m2, their mean (range) age was 3.4 (0.2-9.1) years, and 23 (61%) were greater than two standard deviations below the mean for height. After intensive medical management of their chronic renal failure, half of the children who presented before 2 years of age showed appreciable catch up growth. Only a slow improvement in growth occurred in most children presenting over 2 years of age. At final assessment, the mean (range) glomerular filtration rate was 15 (6-42) ml/min/1.73(2) and 20 (53%) were greater than two standard deviations below the mean for height. There was no correlation between glomerular filtration rate and growth. There remained a group of children who continued to grow poorly. Many of these were of low birth weight, and had dysplastic kidneys.