What is growth failure in children with chronic kidney disease?

One of the most common complications of chronic kidney disease in children is growth failure. Growth failure means uneven growth in children. If a child is shorter than other children of her or his same age and sex then this means he or she is suffering from growth failure. Chronic kidney disease cannot be cured by any type of treatment and gets worse over time. 

Most healthcare providers use charts for monitoring the growth of children with chronic kidney disease and looking for the sign of growth failure in them. Particularly growth charts for children use percentiles for comparing the height of a specific child with other children of the same age and gender. 

Around thirty-three percent of the children with chronic kidney disease in the world are suffering from growth failure. Children who get diagnosed with chronic kidney disease in their younger age are at higher risk of growth failure development in them and having more health problems related to chronic kidney disease and growth failure. 

What are kidneys and what are their work?  

Kidneys are particularly wrist sized and wrist shaped organs located at the bottom of the rib cage from at the human’s backside. One kidney is present at each side of the spine. The kidneys specifically performed the filtration work of the blood and removed its impurities in the form of urine. The amount of urine produced by the kidneys depends upon the age of the person, usually children produce less amounts of urine as compared to adults. Kidneys filter waste and toxins (urine) from the blood and further send it to the bladder from the thin tunes made up of muscles known as ureters. The urine gets stored in the bladder and later flows out from the tube called urethra, which is located underneath the bladder. 

What is the cause of growth failure in children with chronic kidney disease? 

In recent research it is found that many factors can be the cause of growth failure in children with chronic kidney disease. Abide of waste and excess liquid filtration, the kidney also performs an important role in child’s growth. Knowing the kidney’s normal functioning and growth can be helpful for families to understand the causes of growth failure in patients of chronic kidney diseases.  

Functioning of normal kidneys helps in maintaining: 

• The levels of vital minerals and nutrients such as phosphorus and calcium in the blood. For normal bone growth these minerals are necessary. A specific type of hormone known as calcitriol is used by the kidneys for the production of vitamin D, which helps the bone to absorb the appropriate amount of calcium from the blood. Kidneys also perform the role of removing excess phosphorus from the blood and balancing the levels of calcium and phosphorus.

• The balance of sodium (Na) which is known as salt simply. 

• The levels of acid and base in the blood. Acid-base refers to the levels of acid in the blood. 

• The levels of erythropoietin in the blood. Erythropoietin is a special type of hormone which helps bone marrow in the production of the red blood cells. 

• Ability of the body to utilise hormones which are responsible for growth. Growth hormones are one of the most required hormones during childhood in order to help the growth of bones and keep them healthy. 

Complications which can be caused by damaged kidneys and are able to slow a child’s growth includes: 

• Decreased appetite is also a complication which can be caused by damaged kidneys and are able to slow a child’s growth. A child who is suffering from chronic kidney disease may not be hungry, either there will be no energy left for eating in his or her body, which can result in poor nutrition and makes the child’s growth slower. 

• Decreased levels of erythropoietin in the body. The low levels of erythropoietin can cause anemia in most of the children. Anemia is the type of condition in which the levels of red blood cells decrease in the body because of which oxygen cannot be transported all over the body. Anemia can be responsible for slowing or stopping child’s growth. 

• Prevent the child’s body from using growth hormones appropriately. After the kidneys get damaged, the blood gets filled with waste substances and the body becomes unable to process growth hormones properly. 

• Increased production of urine, which is known as polyuria. Polyuria can disrupt the fluid balance of the body. If a child gets polyuria then he or she loses necessary minerals from their body. Getting those lost minerals from the body back slows the child’s growth. 

• Bone and mineral disorders can also occur due to damaged kidneys when: 
  • The levels of phosphorus increases in the blood because of which the calcium is released from the bones to the blood and results in bone weakening and causing an imbalance of potassium, sodium, and levels of acids and bases in the blood, which is known as acidosis. When the substances of blood are not completely balanced the body slows its growth and focuses the energy in making the balance.
  • Vitamin D is unable to be converted into calcitriol and bone doesn’t get calcium properly.

How to treat growth failure in children with chronic kidney disease? 

Mostly for treating growth failure in children with chronic kidney disease healthcare providers use three three treatment methods which includes: 

• Medication 
• Change in eating, diet and nutrition. 
• Growth hormone therapy. 

It is very much necessary to start the treatment for growth failure in children with chronic kidney disease as early as possible because many children with chronic kidney disease grow only about one third of their adult height within the first two years of life. 

Nutrition, eating and dieting 

Most of the children suffering with chronic kidney disease lack the energy to eat or lose their appetite. For treatment of growth failure in child health care provider will most probably suggest few dietary changes such as: 

• Including Vitamin D in diet. Supplements of vitamin D will be needed by the children who do not get sufficient vitamin D from their dietary intake. 

• Avoiding foods with high phosphorus containment. If any child with chronic kidney disease has bone and mineral disorder then he or she will be required to avoid intaking the foods with high phosphorus containment. 

• Including calcium rich foods in diet. It is good for children with chronic kidney disease to include calcium rich foods in their diet or from calcium supplements.

• Fluid intake monitoring. It is also a necessary thing to balance the fluid intake of children with chronic kidney disease. In some children with chronic kidney disease fluid intake needs to be increased, while in some children fluid intake needs to be restricted.

• Balancing protein intake. Children with chronic kidney disease should intake an appropriate amount of protein for their growth, but they should avoid consuming a high protein diet because it can be dangerous for their kidneys. 

• Balancing sodium intake. The requirement of sodium amount in the children with chronic kidney disease depends upon many factors such as their age and stage of kidney disease. Most health care providers suggest the addition of salt in a child’s diet in the form of salt. 

In order for happiness and safe care, both the parents and the healthcare providers should discuss the use of alternative and complementary therapies such as dietary supplements with each other.

For some children a feeding tube is used for providing nutrition to them. A feeding tube is particularly a type of small plastic tube which is placed from the mouth or nose to the stomach for providing food artificially. 

Developing healthy eating habits in children can be helpful in reducing the risk of growth failure and promoting healthy growth. Parents and health care provider teams can work together to prepare a healthy diet schedule for fulfilling the child’s body’s requirement. 

Medications

• Some alkaline agents such as sodium bicarbonate can be prescribed by the child’s health care provider for restoration of acid and base levels in children with acidosis. 

• For the treatment of anemia in child’s with chronic kidney disease a man-made form of erythropoietin known as synthetic erythropoietin is given through the injection. 

• Most probably a healthcare provider will suggest phosphate binders if the levels of phosphorus is high in the child’s blood and causing problems in growth and formation of the bones. Phosphate binders comes in many forms such as capsules, pills, chewable tablets and liquids. 

Growth Hormone Therapy 

After diagnosing a child with chronic kidney disease when the signs and symptoms starts appearing of growth failure starts appearing in the child in that case the injection of daily human growth hormone is prescribed by the healthcare providers. The injection of daily human growth hormone are particularly man made growth hormones which fulfills the need of natural growth hormones found in the body. I researches it is discovered that the use of the injection of daily human growth hormone can be helpful for the children with chronic kidney disease to achieve the average adult height.