Delayed growth and pubertal development are common in children with chronic kidney disease. New and better treatments may mean better growth and development for affected children, but can also expose them to other issues such as early pubertal development.
By Carmit Ziv
Children with chronic kidney disease (CKD) suffer from poor nutrition, chronic inflammation and the accumulation of detrimental substances (such as urea) due to a gradual loss of kidney function. They often undergo treatment with steroidal drugs. All of these factors affect growth and puberty, and it is common for children with CKD to be shorter relative to their families and peers as well as to enter puberty later than average.
With improved approaches to treatment for children with CKD – such as kidney transplantation at an earlier age and better medications – patients may now achieve normal pubertal onset and progression.
Puberty in girls normally starts between the ages of 8 and 13. Genetics play a significant role in the timing of puberty, as does nutrition; studies show that obesity may be a contributing factor in earlier breast development in girls. The mean age of puberty worldwide appears to be declining. Early puberty can be emotionally distressful, and may also have physical effects such as a reduction in height gain.
To assess growth and pubertal development in children with CKD, researchers from Shaare Zedek Medical Centre in Israel followed 112 children (67 boys, 45 girls) between the ages of 2 and 18 over several years (January 2010 to July 2018). All had received a kidney transplant to avoid kidney failure.
During this period, the researchers observed six girls (aged between 6.5 and 9 years old) with “precocious”, or rapidly progressive early puberty, either before or following kidney transplantation. All six girls showed clinical features and laboratory test results consistent with early puberty. They also all had a predicted final height that was less than their genetic potential for height. Three of the girls were obese and two overweight.
In the corresponding research article, recently published in the Journal of Pediatric Endocrinology and Metabolism, the researchers concluded that obesity may be a contributing factor in early puberty in girls following renal transplantation, especially in those with good kidney function as a result of the transplant. With improvements in treatment for chronic diseases, physicians should be aware that the ailments of the general population, such as obesity and early puberty, can affect these patients as well.
Read the original article here:
Carmit Avnon Ziv, Shimrit Tzvi-Behr, Efrat Ben-Shalom, Choni Rinat, Rachel Becker-Cohen, Floris Levy-Khademi, Jenny Goichberg, Harry J. Hirsch, Yaacov Frishberg: Early puberty in end stage renal failure and renal transplant recipients, 29.05.2019.