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.

Nutritional management of the infant with chronic kidney disease stages 2–5 and on dialysis

“…The consequences of poor nutrition during infancy are suboptimal growth and impaired achievement of final height potential, abnormal body composition, developmental delay, a worsening of uremic symptoms such as vomiting, protein-energy wasting, and increased mortality. This period of nutritional vulnerability may be prolonged in CKD as the infantile phase of growth may extend from birth to 2–3 years of age [ 2 ]. Normally, linear growth slows towards the end of the infantile phase, followed by a transient acceleration of growth around 1 year of age at the beginning of the childhood phase of growth; the consequence of this delayed infantile phase in CKD is a slower overall rate of growth.…”

Growth and body composition in children with chronic kidney disease

“…In infancy, untreated CKD is associated with severe growth retardation with loss in relative height being as high as SD 0•6 per month during the first year of life (Rees et al 1989;Karlberg et al 1996). Feeding problems experienced in these infants with its concomitant anorexia and uraemia results in protein -energy malnutrition, which in turn leads to increased protein catabolism and ultimately growth retardation, which may also explain the failure of some of these infants to exhibit catch-up growth.…”

Management of Denys-Drash syndrome: A case series based on an international survey

“…The risks associated with dialysis, and with transplantation, are amplified in younger children, with the highest mortality risks in the youngest children [ 17 ]. In addition, the first 2 – 3 years of life are a critical period for growth and cognitive development [ 18 ]; ESRD in infancy and early childhood may have an irreversible negative impact on growth and development [ 19 ]. Furthermore, most centers require that children reach 10 kg before becoming eligible for transplant; bilateral nephrectomy prior to 10 kg will likely prolong dialysis, rather than reducing its duration.…”

“…Furthermore, given small numbers, it is not possible to draw firm conclusions about optimal management based on our survey data. The proposed recommendations are based primarily on known risks associated with ESRD [ 18 , 19 ] and Wilms’ tumor [ 28 , 30 , 32 ]. Despite an uncertain course, overall prognosis is likely superior when renal function is preserved as long as possible, even if Wilms’ tumor develops.…”