Bechara Rouba, Rossignol Sylvie, Zaloszyc Ariane
Pédiatrie 1, CHU de Hautepierre, Hôpitaux universitaires de Strasbourg, 67000 Strasbourg, France.
Med Sci (Paris). 2023 Mar;39(3):271-280. doi: 10.1051/medsci/2023034. Epub 2023 Mar 21.
Growth failure is a frequent complication observed in children with chronic kidney disease (CKD) and correlated to increased morbidity and mortality. To achieve a normal growth in children with CKD remains challenging for pediatric nephrologists. Growth failure in the setting of pediatric CKD is multifactorial and related to an impaired sensitivity to growth hormone and to a deficiency of IGF1 (insulin-like growth factor 1). Growth failure management has improved during the last two decades and consists of correcting any nutritional and metabolic abnormalities, of an improvement of dialysis for children on end-stage renal disease, and of an administration of a supraphysiologic dose of recombinant growth hormone to overcome GH insensitivity. This article summarizes the causes, outcomes and assessment tools of growth in children with CKD as well as the management of recombinant growth hormone.
生长发育迟缓是慢性肾脏病(CKD)患儿常见的并发症,与发病率和死亡率增加相关。对于儿科肾病学家来说,使CKD患儿实现正常生长仍然具有挑战性。儿科CKD患者的生长发育迟缓是多因素的,与生长激素敏感性受损和胰岛素样生长因子1(IGF1)缺乏有关。在过去二十年中,生长发育迟缓的管理有所改善,包括纠正任何营养和代谢异常、改善终末期肾病患儿的透析治疗,以及给予超生理剂量的重组生长激素以克服生长激素不敏感。本文总结了CKD患儿生长发育的原因、结果和评估工具,以及重组生长激素的管理。