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Effects of uremia on growth in children
J D Hanna1, R J Krieg, J I Scheinman
1Department of Pediatrics, Medical College of Georgia, Augusta, USA.
Insights
Uremia causes growth failure in children. Addressing metabolic acidosis, bone disease, and using growth hormone therapies can improve outcomes, alongside nutritional management and erythropoietin for anemia.
Area of Science:
- Pediatric Nephrology
- Pediatric Endocrinology
- Growth Disorders
Background:
- Uremia in infants and children frequently leads to significant growth failure.
- Multiple factors contribute, including metabolic acidosis, renal osteodystrophy, hyperparathyroidism, and nutritional-endocrine issues.
Purpose of the Study:
- To review the complex issue of growth failure in pediatric uremia for nephrologists.
- To highlight the collaborative role of endocrinologists and nephrologists.
- To summarize current and emerging treatment strategies.
Main Methods:
- Review of existing literature on uremic growth retardation.
- Discussion of contributing factors and their management.
- Highlighting findings from a National Institutes of Health (NIH)-funded clinical trial.
Main Results:
- Uremic growth retardation is multifactorial, requiring comprehensive management.
- Collaborative care involving endocrinology and nephrology is crucial.
- Emerging therapies like recombinant human growth hormone and insulin-like growth factor show promise.
Conclusions:
- A multi-pronged approach is necessary to reverse uremia's effects on growth.
- Conservative nutritional management, erythropoietin for anemia, and post-transplant care are key.
- Further research and clinical trials are essential for optimizing growth in these patients.
Abstract:
Growth failure is a major complication of uremia in infancy and childhood. The influence of the primary renal disease leading to uremic growth retardation in children, the contributing factors leading to growth failure, such as metabolic acidosis, renal osteodystrophy, hyperparathyroidism, nutrition-endocrine and developmental disorders, are reviewed to update nephrologists on the complex issue of growth failure in children with uremia. The collaboration between endocrinologists and nephrologists in treating children with growth retardation is highlighted by a recently completed National Institutes of Health (NIH)-funded clinical trial on renal osteodystrophy plus the use of recombinant human growth hormone and insulin-like growth factor. Finally, this article concludes with a brief summary of an approach to reverse the effects of uremia on growth, including conservative nutritional management, treatment of anemia with erythropoietin, and selected aspects of growth and development after renal transplantation.