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[Spontaneous growth of children with chronic renal failure]
C Kohlhauser1, E Balzar, H Frisch
1Universitäts-Kinderklinik Wien.
Insights
Children with chronic renal failure (CRF) experience growth failure. Therapies like hemodialysis, conservative treatment, and transplantation did not significantly improve height in pediatric CRF patients.
Area of Science:
- Pediatric Nephrology
- Growth and Development
Background:
- Chronic renal failure (CRF) in children is associated with significant growth failure.
- Understanding the impact of various treatments on growth is crucial for managing pediatric CRF.
Purpose of the Study:
- To retrospectively analyze spontaneous growth in 30 pediatric patients with CRF.
- To investigate the influence of conservative therapy, hemodialysis, and kidney transplantation on growth.
Main Methods:
- Retrospective analysis of growth data in 30 patients diagnosed with CRF.
- Evaluation of height standard deviation scores (SDS) before and after interventions.
- Comparison of growth outcomes across different treatment groups: conservative, hemodialysis, and post-transplantation (with varying immunosuppression).
Main Results:
- Patients presented with reduced height SDS at diagnosis (mean -1.46 SDS).
- Height SDS further decreased in hemodialysis and conservative treatment groups over 2-3 years.
- Kidney transplantation (Tx) did not lead to significant height improvement, irrespective of immunosuppressive therapy.
Conclusions:
- Neither hemodialysis, conservative treatment, nor kidney transplantation significantly altered height SDS in pediatric CRF patients.
- Further investigation into pathogenetic factors contributing to growth failure in pediatric CRF is warranted.
Abstract:
Several pathogenetic factors may contribute to the growth failure in patients with CRF. We have analysed retrospectively spontaneous growth in 30 patients with CRF and investigated the influence of various therapies (conservative therapy, hemodialysis and transplantation with different immunosuppressive therapy) on spontaneous growth. At diagnosis (age 8.5 +/- 0.8 years; mean +/- SEM) height was reduced in the whole group (-1.46 +/- 0.2 SDS; x +/- SEM). Height SDS decreased further during the observation period of two and three years in the hemodialysis group (-2.19 +/- 0.69) and in the group with conservative treatment (-2.58 +/- 0.93), respectively. After Tx (n = 26) patients received different types of immunosuppressive therapy: 18 patients received cyclosporin A and prednisone (4-6 mg/m2 BS) daily; 8 transplanted patients received azathioprine (2 mg/kg BW) additionally. After Tx height improved not significantly (-2.02 +/- 0.30 vs. -1.49 +/- 0.36 SDS and -2.52 +/- 0.64 vs. -2.05 +/- 0.24 SDS after three and two years, respectively) irrespective of the immunosuppressive therapeutic regime. In the whole patient group neither hemodialysis nor conservative treatment nor Tx caused a significant change in height SDS; the possible factors, that might be involved in growth failure, are discussed.