GROWTH-RETARDATION IN CHILDREN WITH CHRONIC RENAL-INSUFFICIENCY - CURRENT ASPECTS OF PATHOPHYSIOLOGY AND TREATMENT

The pathogenesis of growth retardation in children with chronic renal failure (CRF) is clearly multifactorial involving malnutrition, metabo lic acidosis, renal osteodystrophy and hormonal disturbances. In parti cular, alterations of the growth hormone (GH)/insulin-like growth fact or (IGF)-axis are pathogenic. Insensitivity to the somatotropic action of GB, decreased IGF-I secretion rate and decreased IGF bioactivity a re operative in children with CRF, while in children post transplantat ion, glucocorticoid-induced GH hyposecretion and local inhibition of I GF action play a pivotal role besides the consequences of graft dysfun ction, Optimization of nutritional support, supplementation with oral bicarbonate preparations, prevention of renal osteodystrophy by phosph ate restriction and vitamin D therapy, and in end-stage renal disease initiation of dialysis are the basis of therapy. These methods can at most stabilize growth, but cannot induce true catch-up growth, apart f rom nutritional support in early infancy. In children posttransplant, catch-up growth is restricted to young patients with near-normal graft function and a lo cv-dose, preferably alternate-day glucocorticoid re gimen, The perspective for growth-retarded children with CRF has impro ved only recently by the introduction of rhGH therapy, RhGH has proven to be an effective, safe and well tolerated new treatment modality fo r growth retarded children at all stages of CRF, There is strong evide nce that final height will increase in these children. In children pos ttransplant, rhGH is also effective, but the potential risk of interfe rence with graft function has not yet been sufficiently defined.