Growth in children with moderate renal insufficiency: measurement, evaluation, and treatment.

Essential in the treatment of children with chronic renal insufficiency (CRI) is the elimination of growth deficits. With the prospect of recombinant human growth hormone (rhGH) and other adjunct treatment, the appropriate measurement and assessment of growth retardation and growth recovery will document continued progress toward eliminating this disabling condition. Phases and determinants of growth at different ages are best described by growth velocity patterns. Nutritional, hormonal, and metabolic determinants interact throughout each phase of growth. Potential for growth loss and recovery is greatest during infancy and early childhood, as shown by the growth velocity index (GVI) of change in height standard deviation score (SDS) (deltaHt - SDS) divided by the growth velocity - SDS (GV - SDS) (GVI = deltaHT - SDS/GV - SDS). An appropriate target height based on potential from mid-parental heights should be set before intervention to establish goals for duration of treatment. Ultimate adult height is the only true measurement of outcome, although predictive formulas based on parental heights and bone age versus chronologic age (BA/CA) are mathematic tools to gauge the efficacy of ongoing regimes. True catch-up growth is defined as the full recovery of lost percentiles and cannot be assumed with an increase in growth velocity or incremental gain in Ht-SDS.