Growth Hormone Disorders and Abnormal Stature in Kidney Disease

Document Type

Book Chapter

Publication Date

2019

Identifier

DOI: 10.1007/978-3-319-97765-2_21; ISBN: 978-3-319-97765-2

Abstract

Growth retardation is the most visible of all the comorbidities associated with the development of chronic kidney disease (CKD) in children. In addition to the cosmetic impact, poor growth has been associated with an impaired health-related quality of life and increased rates of morbidity and mortality. Factors which contribute to the development of this complication include inadequate nutrition, abnormal bone metabolism, salt depletion, cause and severity of the primary renal disorder, metabolic acidosis, delayed puberty, and abnormalities of the growth hormone/insulin-like growth factor I (GH/IGF-I) axis. Evaluation for and treatment of the modifiable risk factors are mandatory to enhance height velocity. Attention to nutritional deficiencies is most important during infancy and often requires enteral tube support to achieve nutritional targets. The use of recombinant human growth hormone (rhGH) has proven to be safe and efficacious in the setting of CKD-related growth hormone resistance, with the best results experienced by those receiving pre-end-stage renal disease (ESRD) therapy, in contrast to the dialysis and transplant populations. Despite the efficacy of rhGH, its underutilization is prevalent and obstacles to its use must be overcome if the growth of the CKD population is to be optimized.

Journal Title

Endocrine Disorders in Kidney Disease

First Page

293

Last Page

307

Keywords

Growth; Nutrition; Growth hormone; IGF-I; Puberty

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