Early age-dependent growth impairment in chronic renal failure

Abstract

We report early linear growth in 73 children (51 boys, 22 girls) with early onset of chronic renal failure (CRF). The inclusion criteria was onset of CRF before 6 months of age, two or more height measurements during the 1st year of life, follow-up for at least 3 years and continuously impaired renal function with a glomerular filtration rate below 50 ml/min per 1.73 m2 at 1 year or later. Only height measurements taken during conservative treatment or dialysis were included. The data were analysed in terms of the infancy-childhood-puberty growth model. There was an age-dependent growth failure in early life leading to an attained height of -3 standard deviation score (SDS) at 3 years of age. Approximately one-third of the reduction in height occurred during fetal life and one-third during the first postnatal months. Between 0.75 and 1.5 years of age height also decreased by 1 SD as a consequence of a delayed onset of the second, the 'childhood', phase of growth in 36% of the patients and by an 'offset childhood' growth pattern--i.e. a return to the infancy phase pattern after onset of the childhood phase--in 60% of the patients. Growth between 0.25-0.75 and 1.5-5 years of age was generally percentile parallel and thus less likely to be affected in CRF with early disease onset. The glomerular filtration rate was not related to the height gain in early life. We speculate that the growth failure during fetal life and the first postnatal months reflects metabolic and/or nutritional influences and the impaired growth at 0.75-1.5 years of age is related to a partial insensitivity to growth hormone.

Early prognostic factors of infants with chronic renal failure caused by renal dysplasia

“…Karlberg et al [17] reported that early onset of CRF was associated with an age-dependent growth delay. One-third of the reduction in height occurs during fetal life and one-third during the first postnatal months, probably due to metabolic and/or nutritional impairment.…”

Catch-up growth follows an abnormal pattern in experimental renal insufficiency and growth hormone treatment normalizes it

“…This reduced potential to maximally accelerate growth might be present in children with early-onset chronic renal insufficiency and explain why height retardation of these patients worsens in infancy and puberty, periods of life where growth velocity is normally very high. 2 The phenomenon of catch-up growth was accompanied by expansion of growth cartilage and its hypertrophic zone in rats with normal renal function as well as in rats with CRF. The height of growth cartilage columns is the result of the dynamic equilibrium between two vectors.…”

“…The typical growth pattern of a child with congenital CRF whose adult height becomes stunted comprises two periods, infancy and puberty, during which the height deficit worsens, that is, there is a further deviation from the normal percentiles, and the mid-childhood period during which the growth rate parallels the normal growth channel. 2,3 This pattern suggests that the ability to accelerate growth velocity is reduced in individuals with CRF.…”

Applying the Growth Failure in CKD Consensus Conference: Evaluation and treatment algorithm in children with chronic kidney disease

“…Malnutrition may be an important contributor to growth impairment in some children, particularly younger children, with CKD [7,9,13,14]. Decreased caloric intake, complicated by an increased incidence of nausea and emesis, is often seen in children with CKD.…”