Delayed menarche in girls with chronic kidney disease and the association with short stature

Kim, Hannah S.; Ng, Derek K.; Matheson, Matthew B.; Atkinson, Meredith A.; Warady, Bradley A.; Furth, Susan L.; Ruebner, Rebecca L.

doi:10.1007/s00467-020-04559-7

Cited by 22 publications

(17 citation statements)

References 22 publications

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“…Menarche occurred timely in the rhGH group but was delayed by approximately 1 year in the non-prior rhGH group. Previous studies showed that longer duration of CKD, corticosteroid use, and lower GFR as well as shorter stature were associated with delayed menarche [30], and that girls with delayed menarche had lower bone mass density [31], which is in line with our results. Taken together, our data suggest that pre-treatment with rhGH improves growth as well as sexual and skeletal maturation after KT.…”

Section: Discussionsupporting

confidence: 93%

Growth hormone treatment in the pre-transplant period is associated with superior outcome after pediatric kidney transplantation

et al. 2021

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Background Recombinant human growth hormone (rhGH) is frequently used for treatment of short stature in children with chronic kidney disease (CKD) prior to kidney transplantation (KT). To what extent this influences growth and transplant function after KT is yet unknown. Methods Post-transplant growth (height, sitting height, leg length) and clinical parameters of 146 CKD patients undergoing KT before the age of 8 years, from two German pediatric nephrology centers, were prospectively investigated with a mean follow-up of 5.56 years. Outcome in patients with (rhGH group) and without (non-prior rhGH group) prior rhGH treatment was assessed by the use of linear mixed-effects models. Results Patients in the rhGH group spent longer time on dialysis and less frequently underwent living related KT compared to the non-prior rhGH group but showed similar height z-scores at the time of KT. After KT, steroid exposure was lower and increments in anthropometric z-scores were significantly higher in the rhGH group compared to those in the non-prior rhGH group, although 18% of patients in the latter group were started on rhGH after KT. Non-prior rhGH treatment was associated with a faster decline in transplant function, lower hemoglobin, and higher C-reactive protein levels (CRP). After adjustment for these confounders, growth outcome did statistically differ for sitting height z-scores only. Conclusions Treatment with rhGH prior to KT was associated with superior growth outcome in prepubertal kidney transplant recipients, which was related to better transplant function, lower CRP, less anemia, lower steroid exposure, and earlier maturation after KT. Graphical abstract A higher resolution version of the Graphical abstract is available as Supplementary information

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Section: Discussionsupporting

confidence: 93%

Growth hormone treatment in the pre-transplant period is associated with superior outcome after pediatric kidney transplantation

et al. 2021

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“…However, onset of menarche was less delayed compared to INC patients managed in the late 20th century, 23 a time before the introduction of cystine-depleting therapy as standard treatment. Not only short stature has been described to have an association with delayed menarche in CKD patients, 37 but also body fat is known to have an impact on pubertal maturation, with menarche occurring earlier in girls with higher body fat. 38,39 Therefore, lower body fat stores in female INC patients may at least partly explain delayed pubertal maturation in the present study.…”

Section: Discussionmentioning

confidence: 99%

Body growth, upper arm fat area, and clinical parameters in children with nephropathic cystinosis compared with other pediatric chronic kidney disease entities

Kluck

Müller

Jagodzinski

et al. 2022

J of Inher Metab Disea

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Children with infantile nephropathic cystinosis (INC), an inherited lysosomal storage disease resulting in cystine accumulation in all body cells, are prone to progressive chronic kidney disease (CKD), impaired growth and reduced weight gain; however, systematic anthropometric analyses are lacking. In this prospective multicenter study we investigated linear growth, body proportion, body mass index (BMI), upper arm fat area (UFA) and biochemical parameters in 43 pediatric INC patients with CKD stages 1 to 5 and 49 age‐matched CKD controls, with 193 annual measurements. INC patients showed more impaired height than CKD controls (−1.8 vs −0.7 z‐score; P < .001), despite adequate cysteamine therapy, treatment for Fanconi syndrome and more frequent use of growth hormone. Only the youngest INC patients shared the same body pattern with CKD controls characterized by preferential impairment of leg length and rather preserved trunk length. In late‐prepuberty, body pattern changed only in INC patients due to improved leg growth and more impaired trunk length. Mean UFA z‐score in INC patients was slightly reduced in early childhood and progressively decreased thereafter reaching −0.8 z‐score in adolescence, while CKD controls showed a steady increase in standardized BMI and UFA especially during adolescent age. Menarche in female INC patients was significantly delayed compared to CKD controls. Our data indicate that with age and progression of disease, pediatric INC patients undergo unique changes of body growth and fat stores that are distinct from those with CKD stemming from other causes, suggesting other factors apart from CKD to contribute to this development. Pediatric patients with infantile nephropathic cystinosis display more severe impaired linear growth than other peer CKD patients, despite of cysteamine treatment, supplementation for Fanconi syndrome, and more frequent use of growth hormone, with a distinct change of body proportions and overall lower body fat.

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“…In a cross-sectional study of 287 girls with CKD onset before menarche, the median age of menarche was 12 years, though 10% had delayed menarche (defined as menarche at $15 years), which was associated with Black race/ethnicity, lower estimated glomerular filtration rate, corticosteroid use, and longer CKD duration, concluding delayed menarche may suggest a risk of short stature. 44 From the perspective of nephrologists, being aware of age of menarche of female patients is an important consideration as the American Academy of Pediatrics has suggested that the menstrual cycle is a vital sign in female patients. 31 Nevertheless, in a study of 75 nephrologists (95% pediatric, 5% adult) practicing in the United States and Puerto Rico, Vasylyeva et al 45 reported that 17% never/rarely documented the age of menarche of adolescent patients and more than a third never/rarely documented the date of last menstrual period of patients.…”

Section: Kidney Disease and Age Of Menarchementioning

confidence: 99%

Female Reproductive and Gynecologic Considerations in Chronic Kidney Disease: Adolescence and Young Adulthood

Chang

Dumanski

Ahmed

2022

Kidney International Reports

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Chronic kidney disease (CKD) increasingly affects younger people, including adolescents and young adults. CKD among females is accompanied by unique reproductive and gynecologic health concerns; though to date, this area has not been well studied. Hormonal disruptions attributed to CKD may underlie the high prevalence of abnormal uterine bleeding and influence the age of menarche in adolescents. Period poverty as a socioeconomic barrier further exacerbates the female-specific burdens of CKD. Reduced fertility in CKD is likely multifactorial and may be related to a reduction in ovarian reserve, reproductive hormone disturbances, and gonadotoxic medication use in addition to low sexual function and activity. Fertility, sexual function and activity, and risk of sexually transmitted infections increase with transplantation. Pregnancy is possible at any stage of CKD, although often accompanied by high risks of maternal and fetal complications. Contraception is thus an important consideration in CKD, but use is low and the risks and benefits of different forms in the setting of CKD are not well characterized. Though patients with CKD report reproductive health as an important element of care, many nephrologists report lack of confidence and training in this area, highlighting the need for targeted research and education. The unique reproductive health care needs of the growing transgender youth population warrant attention in nephrology training with multidisciplinary input. This review will discuss female reproductive health and gynecologic considerations in adolescents and young adults with CKD while proposing clinical and research strategies to improve this understudied yet important aspect of kidney care.

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Delayed menarche in girls with chronic kidney disease and the association with short stature

Cited by 22 publications

References 22 publications

Growth hormone treatment in the pre-transplant period is associated with superior outcome after pediatric kidney transplantation

Growth hormone treatment in the pre-transplant period is associated with superior outcome after pediatric kidney transplantation

Body growth, upper arm fat area, and clinical parameters in children with nephropathic cystinosis compared with other pediatric chronic kidney disease entities

Female Reproductive and Gynecologic Considerations in Chronic Kidney Disease: Adolescence and Young Adulthood

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