Growth Failure in Children With Kidney Disease
The kidneys play an important role in a child's growth. In addition to cleaning waste and extra fluid from the blood, the kidneys produce hormones that help with red blood cell production. The kidneys also help regulate the amounts and interactions of nutrients, including minerals like calcium, phosphorus, and vitamin D, necessary for growth. Last, the kidneys may also play a role in the metabolism of growth hormone (somatotropin).
The kidneys activate vitamin D so that it promotes the absorption of calcium from food into the intestines. This vitamin D hormone also helps bones absorb the right amount of calcium. Calcium and vitamin D are essential elements for the normal growth of bones.
If the kidneys are impaired, bones do not get enough calcium to grow. One reason is that the production of the vitamin D hormone may be deficient. Impaired kidneys may also let too much phosphorus build up in the blood; consequently, phosphorus keeps calcium from getting to the bones.
The child's doctor may recommend diet changes and food supplements to treat growth failure. Diet changes may include limiting foods that contain large amounts of phosphorus, like milk and other dairy products (except cream cheese and cottage cheese), meat, fish, and poultry. High-phosphorus foods also include some vegetables like broccoli, peas, and beans. Dark breads (e.g., whole wheat, pumpernickel) and many cereals are also high in phosphorus. Since it is impossible to avoid all of these foods, it is necessary for caregivers to work with a dietitian to find a healthy way to limit the phosphorus in the child's diet while maintaining a desirable intake of calories and other nutrients necessary to maintain growth and a healthy general condition.
In addition to limiting phosphorus in the child's diet, the doctor may recommend a phosphate binder. This type of medicine keeps phosphorus in the bowel so that it does not stop calcium from getting to the child's bones. The phosphorus is then excreted with the child's bowel movements. Phosphate binders include chewable tablets that are also used as antacids (e.g., Tums TM ). The child should take the phosphate binder with meals and only according to the doctor's recommendations.
Doctors often recommend calcium supplements for children with kidney disease. (These may be used either as a phosphate binder or to increase the calcium in the child's system. If the calcium supplement is to be used as a phosphate binder, it should be taken with meals. It will not provide extra calcium if used in this way.) If the calcium supplement is intended to provide extra calcium, it should be taken at least an hour after meals so that it is not absorbed by the food.
Another kind of necessary supplement in the management of children with chronic renal disease is the vitamin D hormone. There are different types of vitamin D, and these could be either DHT, calcitriol, or calcifediol. These supplements help the bones absorb calcium and therefore maintain a healthier structure and help somehow in the growth process.
If the child is very short for his or her age as the result of kidney disease, the doctor may consider prescribing human growth hormone; this is injected under the skin. Some questions remain about the usefulness and safety of using growth hormone in kidney patients. Some studies suggest that growth hormone stimulates growth in children with chronic renal conditions or children undergoing maintenance dialysis treatment or transplantation. Other studies indicate that growth hormone may increase the chance for rejection of a transplanted kidney. Another set of studies suggests that use of growth hormone may help treat malnutrition both in children and in adult dialysis patients.
For more information, contact the following organizations:
American Kidney Fund
6110 Executive Boulevard
Suite 1010
Rockville, MD 20852
Phone: 1–800–638–8299
Internet: http://www.akfinc.org
National Kidney Foundation
30 East 33rd Street
New York, NY 10016
Phone: 1–800–622–9010
Internet: http://www.kidney.org
[Top]
Additional Information on Growth Failure in Children With Kidney Disease
The National Kidney and Urologic Diseases Information Clearinghouse collects resource information on kidney and urologic diseases for the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) Reference Collection. This database provides titles, abstracts, and availability information for health information and health education resources. The NIDDK Reference Collection is a service of the National Institutes of Health.
To provide you with the most up-to-date resources, information specialists at the clearinghouse created an automatic search of the NIDDK Reference Collection. To obtain this information, you may view the results of the automatic search on Growth Failure in Children with Kidney Disease.
If you wish to perform your own search of the database, you may access and search the NIDDK Reference Collection database online.
[Top]
The U.S. Government does not endorse or favor any specific commercial product or company. Trade, proprietary, or company names appearing in this document are used only because they are considered necessary in the context of the information provided. If a product is not mentioned, this does not mean or imply that the product is unsatisfactory.
National Kidney and Urologic Diseases Information Clearinghouse
3 Information Way
Bethesda, MD 20892–3580
Phone: 1–800–891–5390
TTY: 1–866–569–1162
Fax: 703–738–4929
Email: nkudic@info.niddk.nih.gov
Internet: www.kidney.niddk.nih.gov/
The National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC) is a service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). The NIDDK is part of the National Institutes of Health of the U.S. Department of Health and Human Services. Established in 1987, the Clearinghouse provides information about diseases of the kidneys and urologic system to people with kidney and urologic disorders and to their families, health care professionals, and the public. The NKUDIC answers inquiries, develops and distributes publications, and works closely with professional and patient organizations and Government agencies to coordinate resources about kidney and urologic diseases.
Publications produced by the Clearinghouse are carefully reviewed by both NIDDK scientists and outside experts.
This publication is not copyrighted. The Clearinghouse encourages users of this publication to duplicate and distribute as many copies as desired.
NIH Publication No. 99–4569
June 1999
[Top]
|
