Growth in children with chronic renal failure on conservative treatment

Abstract

Statural growth and its relationship with degree of renal insufficiency were studied in 42 children and 5 infants with chronic renal failure (CRF). Most of the children had a congenital disease or were already ill in the neonatal period. Average GFR was 34 ml/min/1.73 m2 at the beginning and 16 ml at the end of the follow-up period, which averaged 4.3 years (1 to 12 years). Most patients grew at a normal rate; only 3 out of 42 children (7%) and 3 out of 5 infants lost one standard deviation or more during the follow-up period. No correlation was found between the degree of GFR and growth velocity. Catch-up growth was observed only for a 12-month period in 4 children with a bone age of 7 to 8 years. In 10 out of 11 children who reached puberty while under observation, a normal pubertal growth spurt was observed. Suitable and comprehensive controls and treatment can arrest growth retardation in the great majority of children with CRF after the first few years of life, regardless of their GFR. Achievement of a normal growth pattern in infants with CRF during the first year(s) of life remains a major unsolved problem.

Chronic Renal Failure: An Overview from a Pediatric Perspective

“…In nondialyzed infants, energy intakes should be >100% of the recommended daily allowance [124]. For prepubertal children, energy requirements should be approximately 100% of the recommended daily allowance, and in the pubertal state, it should be comparable to the recommended daily allowance for normal adolescents [123, 124]. Protein restrictions should be prescribed in order to prevent glomerular damage [125, 126, 127].…”

“…Periodic follow-ups of the patients with the monitoring of dietary intake and bioclinical parameters are necessary to detect patients at risk of malnutrition [123]. In nondialyzed infants, energy intakes should be >100% of the recommended daily allowance [124]. For prepubertal children, energy requirements should be approximately 100% of the recommended daily allowance, and in the pubertal state, it should be comparable to the recommended daily allowance for normal adolescents [123, 124].…”

Further Definition of Lipid-Lipoprotein Abnormalities in Children with Various Degrees of Chronic Renal Insufficiency

“…Diet was ascertained by the 3-day record technique; (average) food intake consisted of 8% proteins (1-1.5 g/kg/day), 30% lipids, and 62% carbohydrates. The diet compliance, which was routinely assessed by an expert dietician, was confirmed by the satisfactory growth of the children (16). Seven of the 45 children (16%) were hypertensive; these were treated by combination therapy with the following drugs: hydralazine, methyldhopa, and captopril.…”

Editorial Note / Uremia and the Control of Protein Metabolism

“…It is obvious, therefore, that even a small percentage change in protein turnover persisting for a prolonged period would lead to a severe loss of lean body mass in adults with chronic renal failure (CRF) and impaired growth in children with CRF. In fact, infants with renal insuffi ciency appearing before 6 months of age rarely achieve normal growth, and older children with CRF also gener ally exhibit some degree of growth impairment [7,8]. In adults with CRF as well, anthropometry and measure ment of body fluid spaces suggest a loss of lean body mass [5,9].…”