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[Growth retardation in children with chronic renal disease]
Insights
Growth retardation in children with chronic renal disease (CRD) is complex, influenced by malnutrition and renal dysfunction. Recombinant human growth hormone (rhGH) therapy can improve growth velocity when other interventions are insufficient.
Area of Science:
- Pediatric Nephrology
- Endocrinology
- Growth Disorders
Background:
- Growth retardation is a significant complication in children with chronic renal disease (CRD), impacting quality of life and long-term outcomes.
- The pathophysiology of impaired growth in CRD is multifactorial, involving anorexia, malnutrition, inflammation, anemia, acidosis, and hormonal resistance.
Purpose of the Study:
- To review the complex factors contributing to growth retardation in children with CRD.
- To outline current management strategies aimed at improving growth in this population.
- To discuss the role of recombinant human growth hormone (rhGH) therapy.
Main Methods:
- Literature review of factors affecting growth in pediatric chronic renal disease.
- Analysis of the impact of nutritional status, renal function, and hormonal imbalances on growth.
- Evaluation of treatment modalities including nutritional support, correction of metabolic derangements, and growth hormone therapy.
Main Results:
- Malnutrition is a primary driver of growth retardation in infancy, while renal dysfunction is key from childhood to puberty.
- Factors influencing post-transplant growth include recipient age, glucocorticoid dosage, and allograft function.
- Optimal management involves nutritional support, correction of acidosis, anemia, and electrolyte imbalances.
Conclusions:
- Comprehensive management addressing multiple factors is crucial for improving growth in children with CRD.
- Recombinant human growth hormone (rhGH) therapy is indicated for children with insufficient growth velocity despite optimal supportive care.
- Early and aggressive management can mitigate the long-term adverse effects of growth retardation in pediatric CRD.
Abstract:
Despite recent advances in the management of children with chronic renal disease (CRD), growth retardation remains its most visible comorbid condition. Growth retardation has adverse impact on morbidity and mortality rates, quality of life and education, and in adult patients on job family life, and independent leaving accomodation. Pathophysiology of impaired growth in CRD is complex and still not fully understood. The following complications are: anorexia, malnutrition, inflammation, decreased residual renal function, dialysis frequency and adequacy, renal anemia, metabolic acidosis, fluid/electrolyte imbalance, renal osteodistrophy, growth hormone (GH) and insulin-like growth factor-1 (IGF-1) resistance. Malnutrition is most frequent and most important factor contributing to the degree of growth retardation in infancy. The degree of renal dysfunction is the major determinant of variability in growth from third year of age until puberty onset, while in puberty hypergonadotropic hypogonadism has negative effect. The main factors that influence growth after renal transplantation are the age of the recipient and glucocorticoid drugs dosage with negative effect and allograft function with positive effect. In order to improve growth in children with CRD it is necessary to include: diet with optimal caloric intake, correction of fluid/ electrolyte imbalance, correction of acidosis, renal osteodistrophy and anemia. If growth velocity is insufficient to normalize growth, it is necessary to start recombinant human GH (rhGH) therapy at 0.05 mg/kg per day (0.35 mg/kg per week or 28 IU/m2 per week) administered by subcutaneous injection.
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