Growth retardation in children with chronic renal insufficiency.

Abstract

Progressive growth retardation is a complication of chronic renal insufficiency (CRI) in children and often results in patients attaining a final adult height SD score of -1.88 or worse. Although a host of factors may contribute to the subnormal height velocity associated with CRI, disorders of the growth hormone/insulin-like growth factor (IGF) axis predominate. An excess of one or more of the six IGF binding proteins in the 35-kD serum fractions results in depressed bioactivity of the IGF and impaired stimulation of linear growth. Treatment with recombinant human growth hormone likely increases the IGF levels in the 35-kD serum fractions and restores IGF bioactivity, which is associated with an increase in height velocity. Nevertheless, the use of recombinant human growth hormone remains limited in patients with CRI, and more than one-third of this population are severely growth-retarded. Strategies designed to prevent/correct the growth retardation that accompanies CRI should ideally occur during the pre-end-stage renal disease period.