CKD: Growth

• Endocrine and Growth Abnormalities in Chronic Kidney Disease (Pediatric Nephrology, 7th Ed): https://link.springer.com/referenceworkentry/10.1007%2F978-3-662-43596-0_60

• Assessment of nutritional status in children with kidney diseases - clinical practice recommendations from the Pediatric Renal Nutrition Taskforce: https://link.springer.com/article/10.1007/s00467-020-04852-5

Age/parameter Daily weight gain (g/kg/d)

Premature, currently < 2 kg* 15–20

Premature, currently > 2 kg* 20–30

0–4 months 23–34

4–8 months 10–16

8–12 months 6–11

12–16 months 5–9

16–24 months 4–9

*Use only until reaching term gestational age of 37 weeks

Epi:

• Larger effects in women and pubertal girls

• ↑ stage = ↑ prevalence, ↑ severity

Patho:

• Predominantly thought to be due to a direct uremic toxin effect on hypothalamic function: ↓ inhibitory dopaminergic input → ↑ secretion of prolactin

• ↓ clearance of prolactin also contributes

Mgmt:

• Not routinely monitored, but consider hyperprolactinemia if signs/symptoms present

• Hyperprolactinemia does not correct with dialysis, but treatment of vit D deficiency (w/ 1,25-D3) and anemia of CKD (w/ EPO) seems to improve prolactin levels

• Can be corrected with dopaminergic agonists but not clear if benefit to warrant this

Prognosis:

• Consequences of this are not fully understood, but has been associated with with menstrual disorders and galactorrhea in teens, cardiovascular events in adults

• Does normalize after transplant