| [ Summary ] |
In this article, we described the treatment of growth disturbances and renal osteodystrophy in children with chronic renal failure (CRF). These problems may become obstacles to achieving self-support and to improvement of quality of life.
Growth disturbance is the result of multiple disorders arising in CRF, such as metabolic acidosis, anemia malnutrition, and decreased response to growth hormone (GH) and insulin-like growth factors (IGFs). Therefore, GH therapy is effective in these patients. Recombinant human GH is usually given at 0.175 mg / kg / wk and can be increased up to 0.35 mg / kg / wk when a lower dose proves ineffective. Renal osteodystrophy (ROD) is another important problem. The impairment of calcium and phosphate metabolism causes secondary hyperparathyroidism, which enhances bone absorption and the development of osteitis fibrosa, a major type of ROD. For the treatment of secondary hyperparathyroidism, dietary restriction of phosphate and oral administration of phosphate binding agents are usually recommended. Calcium bicarbonate is commonly administrated at an initial dose of 0.1 g / kg / day. Since active vitamin D analogs are often administrated simultaneously, careful monitoring to avoid hypercalcemia is necessary. Large intermittent doses of active vitamin D analogs are administrated to treat severe secondary hyperparathyroidism. A 0.1 μg / kg / dose of calcitriol is given three times a week. When using alfacalcidol, 0.2 μg / kg / dose is given twice a week. To avoid adynamic bone disease, intact PTH levels should be maintained between 150 and 300 pg / ml. |