Growth hormone treatment of renal growth failure during infancy and early childhood
ABSTRACT Despite major progress in dialysis, nutrition and drug treatment in the past 20 years, growth of infants and toddlers with chronic kidney disease (CKD) remains a major challenge in paediatric nephrology. Our hypothesis is that early growth deficit is one of the most important factors for impaired final height in children with CKD, and we conclude that early implementation of recombinant human growth hormone (rhGH) therapy should be offered to infants with growth failure. Infants with delayed growth, adequate caloric intake and stable parameters of bone metabolism are candidates for rhGH therapy. One predictive factor for the selection of infants for rhGH treatment may be growth retardation at birth. Our conclusion from the limited published data is that the use of rhGH in young children with CKD is effective and safe. Compared with its use in older children, the early use of growth hormone requires lower absolute dosages of rhGH, which therefore reduce the annual treatment costs and allow earlier renal transplantation. Furthermore, an early start on rhGH improves the psychosocial situation later in childhood and may lead to a further improvement in adult height. A multi-centre randomised controlled study should be initiated to analyse the short-term and long-term effects of early rhGH therapy on infants with CKD.
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ABSTRACT: Improving general health, sense of well-being, and quality of life are the primary objectives of renal transplanta-tion in children with chronic kidney disease (CKD). Final adult height achieved has a significant impact on medical, psychological, and social aspects of these patients. Growth is an important indicator of health in children with CKD. It seems intuitive then to expect improvement in growth after renal transplantation. Unfortunately, even with a functioning renal allograft, optimal growth remains elusive at times. Optimizing growth prior to transplant, early identification of growth delay, and timely intervention are essential in achieving optimal final adult height. Multiple factors lead to stunted growth in children after renal transplant.12/2010; 39(12). DOI:10.1002/dat.20523
Article: History of growth hormone therapy[Show abstract] [Hide abstract]
ABSTRACT: Although the importance of the pituitary gland for growth was recognized in late 19(th) century, Growth hormone (GH) therapy was made available for severely GH-deficient children and adolescents only in late 1950s. Use of GH for other conditions was limited because of the limited supply of human pituitary-derived hormone. With unlimited availability of recombinant human GH (rhGH), the scenario of GH treatment has been changed enormously. Currently there is ever increasing list of indications of GH treatment in children, adolescents, and adults.09/2011; 15 Suppl 3(Suppl3):S162-5. DOI:10.4103/2230-8210.84852
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ABSTRACT: Provision of adequate nutrition is a cornerstone of the management of infants and very young children with chronic kidney disease (CKD). Very young children with CKD frequently have poor spontaneous nutritional intake. Because growth depends strongly on nutrition during early childhood, growth in very young children with CKD is often suboptimal. In this review we will consider the mechanisms and manifestations of inadequate nutritional status in very young children with CKD, mechanisms mediating inadequate nutritional intake, and the optimal nutritional management of this special population. In addition, we suggest an approach to the assessment of nutritional status, including the use of body mass index in infants. Five major nutritional components are considered: energy, macronutrients, fluids and electrolytes, micronutrients, and calcium/phosphorus/vitamin D. The use of adjunctive therapies, including appetite stimulants, treatment of gastroesophageal reflux and gastric dysmotility, enhanced dialytic clearance, and growth hormone, is also briefly discussed.Pediatric Nephrology 08/2011; 27(9):1427-39. DOI:10.1007/s00467-011-1983-x · 2.88 Impact Factor