Chronic renal disease and growth in childhood

Growth failure, sometimes of a severe nature, has been recognized for many years as a consequence of chronic renal insufficiency (CRI) in childhood. The factors associated with growth failure, including renal osteodystrophy, anorexia and malnutrition, acidosis, salt wasting, and anemia, have also been recognized for many years. Despite vigorous treatment of these factors, patients with CRI continue to grow poorly. It was hoped that, with modern dialysis and transplantation, these patients would have normal growth or even catch-up growth and therefore overcome the height deficit that accrued during the time they had CRI. Unfortunately, this has not been the case. Although normal growth may be seen after transplantation, catch-up growth is rare. In the past year, studies have been reported demonstrating that supraphysiologic doses of growth hormone will produce catch-up growth in children with CRI. These reports are encouraging and are reviewed here.