Growth failure in children with renal disease : incidence, pathophysiology, new perspectives with growth hormone therapy

Stunted growth is a serious problem for children with chronic renal insufficiency (CRI). Advances in the treatment of renal insufficiency, including dialysis and renal transplantation, have greatly improved the survival rate for these patients. Consequently the failure to grow has become a major issue. Unfortunately. despite intensive medical care, optimized nutrition. vitamin D and mineral supplements, and dialysis, it has proved impossible to improve height velocity.' Growth retardation tends to occur when the glomerular filtration rate drops below 20-30 ml/min/L73m'. Infants with CRI secondary to congenital renal abnonnalities are particularly prone to growth failure during the first years of life. When CRI is first diagnosed in a child, the child's height will often lie below the third height percentile for age. It has been reported that nearly 40% of children that enter dialysis have a height below the third height percentile.

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