Management of Chronic Kidney Disease


Growth

Chronic renal failure (CRF) is associated with growth failure. The aetiology is multi-factorial:

  • Malnutrition (a particular problem for children in whom the onset of CRF is < 2 years, when growth is primarily dependent on nutrition)

  • Electrolyte imbalances (lack of sodium, bicarbonate)

  • Resistance to growth hormone

  • Renal bone disease

Growth hormone levels are normal or high in CRF and bioavailability of insulin-like growth factor 1 (IGF-1) is reduced.  The exact mechanisms behind these findings and the resultant resistance to the action are unclear, but it may be the result of the decreased clearance of IGF binding proteins or changes in the growth hormone and IGF-1 receptors.

Treatment consists of:

  1. Ensuring an adequate intake of protein and calories

  2. Supplementation of the diet with sodium and bicarbonate as necessary

  3. Control of renal bone disease

  4. Use of recombinant human growth hormone

Growth is also affected by a delay in the onset of puberty which commonly occurs in CRF and a reduction in the pubertal height gain.

Successful transplantation is usually associated with catch up growth, although only when steroid doses are reduced to an alternate day rather than a daily regime.


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