Growth Failure in Children With Kidney Disease
The kidneys play an important role in a child's growth. In addition to removing wastes and extra fluid from the blood, the kidneys produce hormones that promote red blood cell production. The kidneys also help regulate the amounts and interactions of nutrients from food, including minerals like calcium, phosphorus, and vitamin D, that are necessary for growth. Finally, the kidneys may also play a role in the metabolism of growth hormone, also called somatotropin.
Calcium and vitamin D are essential for normal bone growth. The kidneys turn vitamin D into an active hormone called calcitriol that helps bones absorb the right amount of calcium from blood. If the kidneys are impaired, bones do not get enough calcium either because the kidneys fail to turn vitamin D into calcitriol or because they let too much phosphorus build up in the blood. The excess phosphorus draws calcium into the blood and blocks it from getting to the bones.
Your child's doctor may recommend limiting foods that are high in 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. A dietitian can help you learn to control phosphorus intake by measuring foods and keeping track of their phosphorus content.
The kidneys turn vitamin D into an active hormone called calcitriol that helps bones absorb the right amount of calcium from blood. Children with chronic kidney disease may need to take a synthetic form of calcitriol or a similar vitamin D hormone. These supplements may be administered by injection or taken orally in pill form.
The child's doctor may recommend dietary changes and food supplements to treat growth failure. Dietary changes involve limiting foods that are high in 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, like whole wheat and pumpernickel, and many cereals are also high in phosphorus. Since avoiding all of these foods is impossible, caregivers must work with a dietitian to find a healthy way to limit the phosphorus in the child's diet while still providing enough calories and other nutrients for growth and health.
In addition to limiting phosphorus in the child's diet, the doctor may recommend a phosphate binder. This medicine binds some of the phosphorus in the bowel so that it is excreted in the child's stool. Phosphate binders come in the form of chewable tablets, liquids, capsules, and pills. Some people can use over-the-counter antacid tablets as phosphate binders because they contain calcium. Your child's doctor, however, may prescribe a newer calcium-free binder if calcium buildup in the blood is a concern. Give your child the phosphate binder with meals and only according to the doctor's recommendations.
Children with chronic kidney disease may also need to take vitamin D medications to help the bones absorb calcium and help build bones. These medications also help in the growth process.
If the child is very short as a result of kidney disease, some doctors prescribe injections of human growth hormone. Questions remain about the usefulness and safety of using growth hormone in patients with kidney disease. Most studies suggest that growth hormone stimulates growth in children with chronic renal conditions or children undergoing maintenance dialysis treatment or transplantation. While some questions remain, almost all pediatric nephrologists believe that the availability of growth hormone has been an important advance in our ability to treat small children with chronic kidney disease.
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For More Information
American Kidney Fund
6110 Executive Boulevard
Suite 1010
Rockville, MD 20852
Phone: 1–800–638–8299 or 301–881–3052
Email: helpline@kidneyfund.org
Internet: www.kidneyfund.org
American Society of Pediatric Nephrology
Northwestern University
Feinberg School of Medicine
Pediatrics W140
303 East Chicago Avenue
Chicago, IL 60611–3008
Phone: 312–503–4000
Fax: 312–503–1181
Email: aspn@northwestern.edu
Internet: www.aspneph.com
National Kidney Foundation
30 East 33rd Street
New York, NY 10016
Phone: 1–800–622–9010 or 212–889–2210
Fax: 212–689–9261
Email: info@kidney.org
Internet: www.kidney.org
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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.
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. The NKUDIC would like to thank Barbara Fivush, M.D., and Kathy Jabs, M.D., of the American Society of Pediatric Nephrology (ASPN), for coordinating the review of this publication by the ASPN's Clinical Affairs Committee: Tej Mattoo, M.D., William Primack, M.D., Joseph Flynn, M.D., Ira Davis, M.D., Ann Guillott, M.D., Steve Alexander, M.D., Deborah Kees-Folts, M.D., Alicia Neu, M.D., Steve Wassner, M.D., John Brandt, M.D., and Manju Chandra, M.D. Frederick Kaskel, M.D., Ph.D., President, ASPN, and Sharon Andreoli, M.D., Secretary-Treasurer, ASPN, also provided comments and coordination.
This publication is not copyrighted. The Clearinghouse encourages users of this publication to duplicate and distribute as many copies as desired.
NIH Publication No. 05–4569
September 2005
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