The Effects of Chronic Renal Failure in Infancy on Growth, Nutritional Status and Body Composition

Abstract

Summaryimportant contributory factor (24) which, compounded by horGrowth, body composition, and nutritional status were assessed monal and metabolic abnormalities, leads to a state of body in 21 children (age range, 0.3-11.9 years) with advanced chronic protein depletion. The similarities between children with CRF renal failure (CRF, glomerular filtration rate <20 ml/min/1.73m2), and those with protein-calorie malnutrition (PCM) have been which had presented in the first year of life. Height standard previously noted (9, 23)' Evidence protein in CRF deviation score was -2 or less in 16 children. Intracellular water includes reduction in alkaline soluble protein on muscle biopsy (ICW), an index of body cell mass, was reduced compared to (17), decreased whole body protein and albumin turnover (4, 16), values predicted for height in 14 children studied under years of decreased plasma and intracellular concentrations of certain esage lGroup I, mean ICW observed:predicted ratio (O/P) 0.67, sential amino acids (7,27), decreased levels of short half-life serum range 0.50-0.931, but was normal in seven prepubertal children proteins (27,47), an increased protein catabolic response to fasting studied between 5-1 1.9 years of age ( G~~~~ 11, mean ICW O/P (221, reduced total body nitrogen (341, and reduced body cell mass 1.01, range 0.88-1.23, P < 0.01 compared to Group I). Both ICW as estimated by measurement of ICW (6,14,15,19) and total O/P and weight for height index increased significantly with age body potassium (TBK) (39, 43). In infancy, when calorie and throughout childhood ( r = 0.79, P < 0.001 and r = 0.62, P < 0.05, protein requirements per kg and rates of growth and nitrogen respectively). In Group I, height standard deviation score corre-accretion are greatest, the of llraemia is likely to be lated significantly with ICW O/P, weight for height index, and particularly severe. Studies confirm that children whose CRF serum transferrin. The most growth retarded children had the dates from life are indeed the most growth retarded (2, 20, most marked reduction in body cell mass, were the most wasted, 33) as a result not of poor growth throughout childhood, but and had the lowest serum transferrin levels. In this group mean rather due to early loss of growth potential (2, 33). Whilst abnorserum transferrin was significantly reduced compared to normal, malities of body composition and metabolism in older children and levels were closely correlated with weight for height index. and adults with CRF have been extensively investigated, no Repeat estimations of ICW, performed in seven Group I children studies on the effects of uraemia in infancy are available. We have after an interval of 0.4-0.8 years, showed an increase towards therefore examined, in a group of infants and children whose predicted in six cases. In Group 11, mean weight for height CRF had presented in the first year of life, the and index was normal (101%, range 90-114%) and significantly greater later effects of their uraemia on growth, nutrition and bod...

Changes in Body Composition in Children following Kidney Transplantation

“…El-Bishti et al [6] found an increase in ECW in 12 pubertal and 7 prepuber tal patients on regular hemodialysis who had normal TBW and decreased ICW. However, in another study of 21 patients agend 0.3-11.9 years, Jones et al [1] reported an increase in TBW and ECW and, in the patients under 3 years of age, a decrease in ICW compartment.…”

“…Children with CRF have been found to have distur bances of growth and body composition [1][2][3][4][5][6][7][8][9][10][11] associated with azotemia, acidosis, hyposthenuria, renal osteodys trophy, endocrine disorders, and resistance to the action of hormones. Other contributing factors include an orexia, nausea, and poor protein and energy intake.…”

“…Children with chronic renal failure (CRF) have im paired growth [1][2][3][4][5] and changes in body composition [I. 6,7] that are similar to those in adults with CRF [8][9][10], Lean body mass (LBM) is decreased, extracellular water (ECW) is increased, and there is a moderate decrease in the intracellular water (ICW) compartment [11][12][13].…”

Uso de hormônio de crescimento em crianças com insuficiência renal crônica: avaliação da composição corporal nos primeiros 18 Meses de tratamento

“…Observam-se nestes indivíduos diminuição da velocidade de crescimento, da massa corporal magra, e do compartimento de água intracelular, com aumento da água extracelular. Estas modificações resultam em alterações nutricionais, metabólicas e hormonais que causam comprometimento do balanço energético e protéico (1)(2)(3).…”

“…Estes autores também observaram diminuição da velocidade de crescimento quando a taxa de filtração glomerular era menor que 25mL/min/1,73m 2 . No entanto, tal achado não foi confirmado em estudos subseqüentes (6)(7)(8).…”