GROWTH IN CHILDREN WITH MODERATE RENAL-INSUFFICIENCY - MEASUREMENT, EVALUATION, AND TREATMENT

Essential in the treatment of children with chronic renal insufficienc y (CRI) is the elimination of growth deficits, With the prospect of re combinant human growth hormone (rhGH) and other adjunct treatment, the appropriate measurement and assessment of growth retardation and grow th recovery will document continued progress toward eliminating this d isabling condition, Phases and determinants of growth at different age s are best described by growth velocity patterns, Nutritional, hormona l, and metabolic determinants interact throughout each phase of growth , Potential for growth loss and recovery is greatest during infancy an d early childhood, as shown by the growth velocity index (GVI) of chan ge in height standard deviation score (SDS) (Delta Ht - SDS) divided b y the growth velocity - SDS (GV - SDS) (GVI = Delta Ht - SDS/GV - SDS) , An appropriate target height based on inherited potential from mid-p arental heights should be set before intervention to establish goals f or duration of treatment. Ultimate adult height is the only true measu re of outcome, although predictive formulas based on parental heights and bone age versus chronologic age (BA/CA) are mathematic tools to ga uge the efficacy of ongoing regimens. True catch-up growth is defined as the full recovery of lost percentiles and cannot be assumed with an increase in growth velocity or incremental gain in Ht - SDS.