Pathophysiology of growth retardation in chronic renal failure

Data concerning the transcription of growth hormone and the various interactions between growth hormone/insulin-like growth factor (IGF) axis in uremia, acidosis and nutrition are presented. The recent evidence of tissue resistance to growth hormone in uremia provided the medical rationale for the use of growth hormone in chronic renal failure. The growth hormone receptor resistance in uremia and the decreased IGF-I by acidosis are additional rationale for the use of growth hormone. New findings of how acidosis causes the reduction of IGF-I expression at the growth plate of the long bone and the significant proteolysis after even small changes in serum bicarbonate content are presented to provide the pediatrician with an overview of these recent advances.