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Growth failure in Chronic Renal Insufficiency

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 function3,4,5​​​​​​​.

Causes2

  • 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

Clinical presentation4

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

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Chronic Renal Insufficiency efficacy & safety

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Genotropin Homecare

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References
  1. 1. NICE Guidance [TA188]. Human growth hormone (somatropin) for the treatment of growth failure in children.
    2. Becherucci F, et al. Clinical Kidney Journal 2016, 9: 583–591.
    3. Van Dyck M, Bilem N, Proesmans W. Pediatr Nephrol 1999, 13(9): 865–869.
    4. Mahan JD, Warady BA. Pediatr Nephrol 2006, 21(7): 917–930.
    5. Haffner D, et al. N Engl J Med 2000, 343(13): 923–930.
PP-GEN-GBR-0907. March 2021

Paediatric Growth Hormone Deficiency

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NICE technology appraisal guidance

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The Genotropin Delivery Portfolio

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PP-PFE-GBR-2688. December 2020

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