Table 2.

Main measures for prevention and treatment of growth failure in pediatric CKD.

Prevention: • Close growth monitoring with intervals depending on previous growth, age and stage of CKD. • Preserve renal function by:   ° Treating elevated blood pressure and reducing proteinuria, preferrably using RAAS inhibitors.   ° Avoiding nephrotoxic medication.   ° Prompt treatment of urinary tract infections. • Provide adequate energy and protein intake and consultation with a renal dietician.   ° “Consider enteral feeding by gastrostomy or nasogastric tube in cases of persistent insufficient oral intake” (21). • Substitute water and electrolyte losses and correct metabolic acidosis. • “Keep PTH levels in the recommended CKD stage-dependent target range and substitute native vitamin D in cases of low vitamin D levels” (22, 23). • Aim for early (preemptive) renal transplantation with minimal steroid exposure in patients with end-stage CKD. • Provide adequate dialysis in patients requiring maintenance dialysis.

Treatment: • “Consider use of growth hormone treatment in cases of persistent growth failure, i.e., height <3rd percentile and height velocity <25th percentile, excluding patients who have received a transplant within the last 12 months” (13). • “Consider intensified dialysis or hemodiafiltration in in patients requiring maintenance dialysis presenting with persistent growth failure” (13). • “Consider use of rhGH therapy in pediatric kidney transplant recipients for whom expected catch-up growth cannot be achieved by steroid minimization, or for patients where steroid withdrawal is not feasible due to high immunological risks, particularly in children with suboptimal graft function (GFR < 50 ml/min/1.73 m2)” (13).

CKD, chronic kidney disease; RAAS, renin-angiotensin aldosterone system; PTH, parathyroid hormone.