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Chronic Renal Insufficency
Chronic renal insufficiency (CRI) is a condition in which the kidneys gradually lose their ability to perform their primary functions, the removal of wastes and extra fluid from the body. Another important function of the kidneys is to regulate the amounts of vitamins and minerals, such as calcium and iron, involved in the growth process. Children with CRI may have difficulty attaining a normal height and weight for several reasons, including slow bone growth, malnutrition, and problems using protein.

Most young people with CRI have normal growth hormone levels, but they don't always grow as well as others their age because their bodies aren't able to use the growth hormone completely.

References
Guyton AC, Hall JE. Textbook of Medical Physiology. 9th ed. Philadelphia, PA: WB Saunders; 1996.

Wilson JD, Foster DW, Kronenberg HM, Larsen PR, eds. Williams Textbook of Endocrinology. 9th ed. Philadelphia, PA: WB Saunders; 1998.


The connection between CRI and growth failure
The kidneys have a number of important functions. When they fail, many different things can go wrong. In CRI, the kidneys slowly lose their ability to function normally. This means that they concentrate urine, conserve salt and water, and lose the ability to excrete wastes. Their role in the growth process is also compromised, which can lead to growth failure.

One of the reasons for this growth failure centers on vitamin D, a nutrient that is activated by the kidneys. Activated vitamin D helps the body absorb calcium from foods, and also helps the bones absorb the right amount of calcium that will enable them to grow. When the kidneys are impaired, they are unable to activate vitamin D, and the bones cannot get enough calcium. Consequently, the growth process is interrupted. It's easy to see how poor nutrition can also contribute to growth failure in young people with CRI.

Often, the signs and symptoms of chronic renal insufficiency aren't evident until after serious damage has already occurred. As CRI progresses, the kidneys may fail to the point where either kidney dialysis (a medical procedure used to remove waste products from the bloodstream) or kidney transplantation becomes necessary to keep the patient alive.

Although a kidney transplant can return a child's growth rate to normal, by that time growth potential may already have been lost. That is why therapy with growth hormone prior to kidney transplantation is an important component of the treatment strategy for chronic renal insufficiency.

References
Guyton AC, Hall JE. Textbook of Medical Physiology. 9th ed. Philadelphia, PA: WB Saunders; 1996.

Wilson JD, Foster DW, Kronenberg HM, Larsen PR, eds. Williams Textbook of Endocrinology. 9th ed. Philadelphia, PA: WB Saunders; 1998.


Can poor growth be an indication of kidney disease?
Kidney disease is quite rare in childhood, and only a very few children who are growing poorly will be found to have kidney disease. Usually, there will be some other cause for their growth failure.

Your child's healthcare provider can best assess the possibility of kidney disease, usually beginning with a detailed health history and physical exam. Follow-up lab tests that measure blood electrolytes, as well as a standard urinalysis, can help confirm the possibility of kidney disease. If the combination of patient history, examination, and testing do not point to kidney disease, chances are good that kidney disease is not the cause of any growth problems.

Evaluating progress
There is a lot of information available that indicates growth hormone can help patients with CRI grow. Research has shown that patients on Primatropin AQ and Primatropin showed substantial growth in the first and second years of therapy.

It may take 3 to 6 months for Primatropin AQ and Primatropin to have a noticeable effect, so it's important that your child keeps his or her appointments with the healthcare team so that bodily changes can be monitored. After a few visits, it will be possible to see whether your child is beginning to grow more quickly than before therapy started.

Reference
Fine RN, Kohaut EC, Brown D, Perlman AJ. Growth after recombinant human growth hormone treatment in children with chronic renal failure: report of a multicenter double-blind placebo controlled study. J Pediatr. 1994;124:374-382.
Treatment of growth failure associated with CRI
Short stature associated with chronic renal insufficiency may be treated with injections of growth hormone up until the time of kidney transplantation.

If a kidney transplant is being considered in the future, an important goal of growth hormone treatment is to optimize your child's height before transplantation, because some of the medication that must be taken after a kidney transplant can interfere with growth.


Frequently Asked Questions

Why do children with CRI need to take Primatropin therapy?
One reason that children with CRI may suffer from abnormal growth and development is related to natural growth hormone. In these children, natural growth hormone does not work as well as it does in those who are healthy. That's why Primatropin therapy is sometimes used to help children with CRI reach their full growth potential.

What is the goal of Primatropin therapy in CRI?
The goal of Primatropin therapy for a child with CRI (up to the time of renal transplantation) is to offset the impact of chronic kidney disease on the growth process and to help the child achieve his or her full adult height potential.

How long will my child have to continue Primatropin therapy?
Children with CRI should continue to receive Primatropin treatments up to the time of renal transplantation, subject to their healthcare provider's medical judgment. With time, Primatropin allows many children with CRI to grow more normally.

Will my child still have to continue taking other kidney medications, while receiving Primatropin therapy?
Yes, children with CRI must continue taking their other kidney medications as prescribed by their healthcare provider in addition to receiving Primatropin therapy. Primatropin merely treats one of the problems of CRI rather than the disease itself. To help the Primatropin therapy work as well as possible, children with CRI must also eat a healthy diet.

Does Primatropin therapy have to be given at any special time of day?
Your healthcare provider will look at your child's overall treatment plan and determine the best time of day to give your child Primatropin treatment. Many children with CRI are on dialysis to help keep them healthy. Growth hormone is broken down by the kidneys, so the type of dialysis the child receives may affect when the Primatropin injection should be given.

 

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