Chronic renal insufficiency
Chronic renal insufficiency (CRI), also called chronic renal failure (CRF), is a condition where a child’s kidneys no longer work well enough to maintain a normal state of health.
The kidney disease associated with CRI gradually affects the filtering capacity of the kidneys, resulting in symptoms which can include failure to grow properly. This leaflet looks at how children’s growth is affected by CRI and what treatment is available to help children achieve normal adult height.
Why might CRI affect children’s height?
- Imbalances in body sodium and potassium as well as an excess build-up of blood acidity can affect a child’s growth.
- Children with kidney disease may not feel like eating, resulting in a malnourished state which can lead to failure to achieve normal height.
- Bone growth can be affected by imbalances in vitamin D, calcium and phosphorus resulting from kidney disease.
- The medications used to treat kidney disease and to prevent rejection of a kidney transplant can also reduce growth.
- Even when all these other factors are corrected, a child with chronic kidney disease may still have a slow rate of growth.
How is CRI diagnosed?
CRI can show up in many ways. A child may be born with kidney malformation or inflammation that can be clearly seen on a prenatal ultrasound. A previously healthy 5 year old may suddenly develop fluid retention or a 10 year old girl may visit the doctor simply because she has a shorter height than her friends. These can all be symptoms of CRI and are associated with slow growth.
The importance of early diagnosis
CRI in children is normally found quite early because of their kidney problems. The earlier the diagnosis, the better the prospects for treatment, which nowadays can offer a better quality of life than was possible even 10 years ago. Doctors specialising in kidney problems are called nephrologists. Children who are shorter than normal are often also seen by a paediatric endocrinologist, who is a doctor specialising in treating children with growth problems.
Helping children with CRI to grow
Daily growth hormone injections can help a child catch up with the growth of other children of the same age during early childhood. Continuing the injections helps maintain normal growth later in childhood, with the final aim of achieving an adult height within the average range. The response to growth hormone treatment varies from one individual to another, but most children who receive treatment over several years remain within the normal growth range for their age.
Some children with CRI who have a shorter height than normal may be given growth hormone treatment to boost their growth. Growth hormone treatment can achieve a gain in height in the first year of treatment, and continuing with the treatment may be beneficial in the longer term. In fact, studies have found that when growth hormone treatment is started early, it has helped children to eventually reach a height within the normal adult range.
Growth hormone injections are normally given once-daily in the evening. At the beginning parents are trained to give these injections when the child is very young. Later on, children can inject themselves with growth hormone when they feel confident enough. Devices are now available that make injecting growth hormone much simpler, more comfortable and less painful. This has been achieved through advances in design such as automated needle insertion and the use of very fine needles. There is a wide choice of devices available, and whilst some require mixing before use and refrigeration once opened, others do not.
To help the doctor select an injection device that matches your requirements, it may help to read the page discussing the features of the various devices.
Although treatment with growth hormone can help a child gain height, it is not a treatment for CRI, which is the underlying cause of the majority of your child’s health issues.
Meeting the challenge of growth problems
Children with CRI can experience emotional and behavioural problems, and these may be made worse if they are growing at a slower rate than other children of the same age. For these reasons, it’s helpful to explain to a child how growth hormone treatment can help to boost their height, and how important it is to continue with the daily treatment. Of course the doctors responsible for the treatment of CRI will be focusing on the kidney problems, but it’s good to know that growth hormone treatment can contribute to helping these children stand out less from friends of their own age.
APROM ID# 1503. December 2009.
