Chronic kidney disease has a major impact on children’s development and quality of life, particularly through its effects on growth. The lower a child’s kidney function, the slower will be their rate of growth. As a result, about a third of children with CKD fall below the third percentile for their age and gender. When kidney function is reduced in infancy the effect is even greater.

There is normally rapid growth in head circumference and brain volume during the first year of life. Poor growth is associated with intellectual impairment and learning difficulties. In older children, reduced growth and delayed puberty are associated with worse physical function and increased mortality. Short stature may lead to low self-esteem and emotional difficulties as children grow up to be adults.

An essential part of the care of any child, especially one with kidney disease, is the charting of height , weight and, for infants, head circumference (Patient 9.1).

Growth failure in kidney disease is mainly due to a functional deficiency of Insulin-like Growth Factor 1 (IGF-1) [1]. Although the serum level of growth hormone is disproportionally high, its stimulatory effect on IGF-1 production by the liver is reduced. Bioactive IGF-1 is reduced and inhibitory IGF binding proteins are increased. The severity of these abnormalities is proportional to the reduction in GFR. Treatment with pharmacological doses of recombinant growth hormone can overcome some of the functional deficiency of IGF-1 (Patient 9.2) .