Todisco Tommaso, Ubertini Grazia Maria, Bizzarri Carla, Loche Sandro, Cappa Marco
Research Unit for Innovative Therapies in Endocrinopathies, Bambino Gesù Children's Hospital, IRCCS, 00165 Rome, Italy.
UOC Endocrinology and Diabetology, Bambino Gesù Children's Hospital, IRCCS, Piazza S. Onofrio 4, 00165 Rome, Italy.
Children (Basel). 2024 Jul 1;11(7):808. doi: 10.3390/children11070808.
Chronic kidney disease (CKD) is a significant challenge for pediatric endocrinologists, as children with CKD may present a variety of endocrine complications. Growth failure is common in CKD, and its severity is correlated with the degree of renal insufficiency. Management strategies include addressing reversible comorbidities, optimizing nutrition, and ensuring metabolic control. Kidney replacement therapy, including transplantation, determines a significant improvement in growth. According to a recent Consensus Statement, children with CKD stage 3-or on dialysis older >6 months-are eligible for treatment with recombinant growth hormone (rGH) in the case of persistent growth failure. Treatment with rGH may be considered for those with height between the 3rd and 10th percentile and persistent growth deceleration. In children who received kidney transplantation but continue to experience growth failure, initiation of GH therapy is recommended one year post-transplantation if spontaneous catch-up growth does not occur and steroid-free immunosuppression is not an option. In children with CKD, due to nephropathic cystinosis and persistent growth failure, GH therapy should be considered at all stages of CKD. Potential adverse effects and benefits must be regularly assessed during therapy. Treatment with GH is safe in children with CKD. However, its general efficacy is still controversial. All possible problems with a negative impact on growth should be timely addressed and resolved, whenever possible with a personalized approach to the patient. GH therapy may be useful in promoting catch-up growth in children with residual growth potential. Future research should focus on refining effective therapeutic strategies and establishing consensus guidelines to optimize growth outcomes in this population.
慢性肾脏病（CKD）对儿科内分泌学家来说是一项重大挑战，因为患有CKD的儿童可能会出现多种内分泌并发症。生长发育迟缓在CKD患儿中很常见，其严重程度与肾功能不全的程度相关。管理策略包括处理可逆的合并症、优化营养以及确保代谢控制。肾脏替代治疗，包括移植，可显著改善生长情况。根据最近的一份共识声明，CKD 3期或接受透析超过6个月的患儿，若持续存在生长发育迟缓，有资格接受重组生长激素（rGH）治疗。对于身高处于第3至第10百分位数且持续生长减速的患儿，可考虑使用rGH治疗。对于接受肾脏移植但仍存在生长发育迟缓的儿童，如果未出现自发追赶生长且无法采用无类固醇免疫抑制方案，建议在移植后一年开始生长激素治疗。对于患有CKD且因肾病性胱氨酸病而持续生长发育迟缓的儿童，在CKD的各个阶段都应考虑生长激素治疗。治疗期间必须定期评估潜在的不良反应和益处。生长激素治疗对CKD患儿是安全的。然而，其总体疗效仍存在争议。所有可能对生长产生负面影响的问题都应及时解决，尽可能采用个性化的患者治疗方法。生长激素治疗可能有助于促进有生长潜力的儿童实现追赶生长。未来的研究应侧重于完善有效的治疗策略并建立共识指南，以优化该人群的生长结局。
