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Growth in children with moderate renal insufficiency: measurement, evaluation, and treatment
C Abitbol1, J C Chan, H Trachtman
1University of Miami/Jackson Memorial Medical Center, Florida, USA.
Insights
Eliminating growth deficits in children with chronic renal insufficiency (CRI) is crucial. Monitoring growth velocity and using recombinant human growth hormone (rhGH) aids in assessing recovery and achieving optimal adult height.
Area of Science:
- Pediatric Nephrology
- Endocrinology
- Growth and Development
Background:
- Chronic renal insufficiency (CRI) in children often leads to significant growth deficits.
- Effective management requires precise assessment of growth retardation and recovery.
- Recombinant human growth hormone (rhGH) offers a therapeutic avenue for improving growth outcomes.
Purpose of the Study:
- To outline essential strategies for measuring and assessing growth deficits in children with CRI.
- To highlight the importance of growth velocity patterns and predictive tools in treatment monitoring.
- To define true catch-up growth and establish criteria for successful intervention.
Main Methods:
- Utilizing growth velocity patterns to describe growth phases and determinants.
- Employing the growth velocity index (GVI) to assess growth recovery potential, especially in early childhood.
- Setting target heights based on mid-parental heights to guide treatment goals.
- Using predictive formulas (e.g., bone age/chronologic age) to evaluate treatment efficacy.
Main Results:
- Growth velocity patterns are key to understanding growth dynamics at different ages.
- The growth velocity index (GVI) effectively quantifies growth recovery potential.
- Ultimate adult height remains the definitive measure of treatment success.
- True catch-up growth signifies full percentile recovery, not just increased growth velocity.
Conclusions:
- Comprehensive assessment of growth velocity and target heights is vital for managing children with CRI.
- Interventions like rhGH require careful monitoring using validated growth assessment tools.
- Achieving ultimate adult height is the primary goal, necessitating a long-term perspective on treatment efficacy.
Abstract:
Essential in the treatment of children with chronic renal insufficiency (CRI) is the elimination of growth deficits. With the prospect of recombinant human growth hormone (rhGH) and other adjunct treatment, the appropriate measurement and assessment of growth retardation and growth recovery will document continued progress toward eliminating this disabling condition. Phases and determinants of growth at different ages are best described by growth velocity patterns. Nutritional, hormonal, and metabolic determinants interact throughout each phase of growth. Potential for growth loss and recovery is greatest during infancy and early childhood, as shown by the growth velocity index (GVI) of change in height standard deviation score (SDS) (deltaHt - SDS) divided by the growth velocity - SDS (GV - SDS) (GVI = deltaHT - SDS/GV - SDS). An appropriate target height based on potential from mid-parental heights should be set before intervention to establish goals for duration of treatment. Ultimate adult height is the only true measurement of outcome, although predictive formulas based on parental heights and bone age versus chronologic age (BA/CA) are mathematic tools to gauge the efficacy of ongoing regimes. True catch-up growth is defined as the full recovery of lost percentiles and cannot be assumed with an increase in growth velocity or incremental gain in Ht-SDS.