Chronic renal insufficiency (CRI), which may include end stage renal disease, is defined as a persistent elevation of serum creatinine and/or urea. CRI can be caused by a variety of conditions, including congenital disorders, glomerular disorders and infections¹.

Chronic kidney disease (CKD) in children is associated with growth impairment, mainly due to disturbances in growth hormone (GH) metabolism and its main mediator, insulin-like growth factor-I (IGF-I)².

Growth failure associated with CRI usually begins when the glomerular filtration rate falls to 50% of normal¹. However, significant short stature has been seen at all levels of renal function^3,4,5.

• Primary causes of CKD in children significantly differ from those that are responsible for the adult onset of the disease
• The main aetiologic factors of CKD in children are represented by CAKUT (congenital abnormalities of kidney and urinary tract), SRNS (steroid-resistant nephrotic syndrome), chronic glomerulonephritis and renal ciliopathies and for >70% of all paediatric CKD cases when considered together
• Less common causes include thrombotic microangiopathies (especially atypical haemolytic uraemic syndrome), nephrolithiasis / nephrocalcinosis, Wilms tumour, infectious and interstitial diseases
• While structural causes clearly predominate in younger patients, the incidence of glomerulonephritis increases in those >12 years old

Children with CRI who have growth impairment exhibit a variety of medical and psychological problems in addition to increased mortality.

Factors contributing to poor growth in children with CKD may include:

• Young age at onset of CKD
• Renal tubular disorders (e.g., renal dysplasia)
• Reduced caloric intake (anorexia, loss of taste, GI dysfunction)
• Inefficient utilisation of calories
• Metabolic acidosis
• Renal osteodystrophy
• Excessive sodium or water losses
• Corticosteroids
• GH–IGF-I resistance

References