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Somatische Reifung des nierenkranken Kindes

Verbesserte Wachstumsprognose

Somatic development in children with kidney disease

Improved growth prognosis

  • Leitthema
  • Published:
Der Nephrologe Aims and scope

Zusammenfassung

Die Gewährleistung einer normalen somatischen Entwicklung ist eine große Herausforderung bei der Behandlung von Kindern mit chronischer Niereninsuffizienz (CKD). In den letzten Jahren führte ein besseres Verständnis der zugrunde liegenden Pathophysiologie zu neuen therapeutischen Ansätzen, die das Wachstum dieser Kinder entscheidend verbessert haben. Im Säuglings- und Kleinkindalter ist die adäquate Kalorienzufuhr, ggf. durch eine perkutane endoskopische Gastrostomie (PEG), die entscheidende Maßnahme, im Kindes- und Jugendalter die Behandlung mit Wachstumshormon (GH). Auch wenn neuere Daten zeigen, dass eine intensivierte Dialysetherapie das Wachstum dialysepflichtiger Kinder steigern kann, sollte bei allen Patienten eine möglichst rasche Transplantation bzw. präemptive Lebendnierentransplantation mit minimaler Steroidexposition angestrebt werden. Unter Beachtung dieser Maßnahmen weisen Kinder mit CKD heute eine weitgehend normale somatische Entwicklung auf. Die Therapie von CKD-Kindern erfordert die frühe Betreuung in einem speziell ausgerichteten pädiatrisch-nephrologischen Dialyse-/Transplantationszentrum.

Abstract

Guaranteeing normal somatic development in children with chronic kidney disease (CKD) is still a considerable challenge. Over the last 20 years, a better understanding of the etiology and pathophysiology of uremic growth failure has been translated into novel therapeutic measurers. During infancy and young childhood adequate nutritional intake is necessary to ensure optimal growth. In later childhood treatment with growth hormone (GH) is required to optimize growth. Although it has been shown recently that intensified dialysis treatment (hemodiafiltration, 6×3 h per week) may improve growth in these children, early transplantation should be the target in all children in this patient group. Preemptive living related transplantation seems to be superior with respect to growth compared to cadaveric transplantation. In patients with stable transplant function, weaning off steroids should be undertaken to allow optimal growth. With theses measures the majority of pediatric CKD patients attain normal somatic development. In order to provide optimal treatment, pediatric and adolescent CKD patients should be referred to pediatric dialysis/transplant units early.

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  1. Universitäts-Kinder- und Jugendklinik Rostock, Ernst-Heydemann-Str. 8, 18057, Rostock, Deutschland

    D. Haffner

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Haffner, D. Somatische Reifung des nierenkranken Kindes. Nephrologe 6, 22–31 (2011). https://doi.org/10.1007/s11560-010-0476-4

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