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Growth and development of nondialyzed children with chronic renal failure
Insights
Early conservative treatment for children with chronic renal failure (CRF) can normalize growth rates and development. Prompt intervention, especially in infancy, is crucial for preventing height loss and improving outcomes in pediatric kidney disease.
Area of Science:
- Pediatric Nephrology
- Growth and Development
- Chronic Kidney Disease
Background:
- Severe kidney disease in children, often congenital, leads to significant growth retardation.
- Growth impairment typically occurs before the initiation of therapeutic interventions.
Purpose of the Study:
- To evaluate the impact of early conservative treatment on growth and development in children with chronic renal failure (CRF).
- To determine the optimal timing for intervention to prevent height loss and promote normal development.
Main Methods:
- Longitudinal follow-up of 34 children with severe kidney disease from infancy to 5-19 years.
- Analysis of growth velocity and height changes before and after treatment initiation.
- Assessment of mental development and pubertal growth spurts.
Main Results:
- Children treated in infancy showed dramatic growth improvement, normalizing growth rates though catch-up growth was rare.
- Those treated after one year of age experienced continued height deficit.
- Normal growth spurts occurred in five children during puberty, irrespective of GFR changes.
- Mental development was normal in 31 out of 34 patients.
Conclusions:
- Normal growth and development are achievable in infants and children with chronic renal failure (CRF).
- Early conservative management is critical to prevent height loss and optimize long-term outcomes.
- Timely intervention is essential for improving growth trajectories in pediatric kidney disease.
Abstract:
Thirty-four children with severe kidney disease, either congenital (32 cases) or developing at birth, were followed until age 5 to 19 years. Overall growth retardation corresponded to -2.5 SD below the mean normal values. The retardation occurred almost exclusively before therapy for it was started. Fifteen children were first treated during infancy. In all of them except one, growth was dramatically improved following the first visit to our center, growth changing from slowed to normal rate, although catch-up growth was rare: the average change from normal mean height was -1.68 SD (or -5 SD per year) calculated for the infantile period up to the first visit to our clinic, followed by a change of +0.18 SD per year between first presentation and age 12 months, and +0.01 SD per year between first presentation and last observation at a mean age of 8.3 years. In the 19 patients who were treated after the first year of life, the mean change of height from birth to first presentation was -0.33 SD per year followed by a mean change of -0.04 SD per year up to the last observation (mean period, 7.3 years). Catch-up growth was exceptional. Five children entered puberty with a normal growth spurt. When GFR deteriorated, growth velocity was unchanged. Height calculated for corresponding bone maturity was reduced in half of the patients when first seen, but progressed to the same degree as height during follow-up, except in one patient. Mental development was normal in 31 of 34 patients. Conclusion. Normal growth rate and normal development is possible in children and even in infants with CRF chronic renal failure. The importance of instituting early conservative treatment to prevent height loss must be emphasized.