VI. GROWTH (Table 17 and NCHS Growth Charts)
We had the weights of the 9 patients assessed for renal
function. Most preoperative heights were not available so we considered only
the pre-operative and post-operative weights. The weights were plotted onto
NCHS ( NATIONAL CENTER FOR HEALTH STATISTICS ) Growth Charts.
Pre-operatively there was growth retardation in 8 patients and 1
had a weight at the 50th percentile.
Analysis showed:
> Between the 25th and 50th percentile : 2 patients >
Between the 10th and 25th percentile : 3 patients > Below the 5th percentile
: 3 patients
At the final evaluation, 5 patients had improvement in their
growth curves and in 4 there was regression in growth.
Analysis showed:
> Above the 95 percentile: 1 patient
> Between the 75th and 90th percentile: 1 patient >
Between the 25th and 50th percentile: 1 patient > At the 25th percentile: 2
patients
> Between the 10th and 25th percentile: 1 patient > At the
10th percentile: 1 patient
> Between the 5th and 10th percentile: 1 patient > Below
the 5th percentile: 1 patient
The mean age at diagnosis of the 5 patients who had an
improved growth was 11.4 months and that of the 4 who had regression of their
growth curve was 42.3 months. KRUEGER R.P et al (15) noted that the follow-up
growth potential was less in those patients presenting at the youngest age and
improved as the age of presentation 76
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POSTERIOR URETHRAL VALVES IN CHILDREN: A review of 28
cases in Yaounde
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increased. KRUEGER's explanation of his findings was that if
renal impairment occurs in infancy, the growth failure is more pronounced than
is when renal disease occurs later in life. According to YURI REINBERG et al
(51) renal function is the only predictor of body growth.
A possible explanation to our findings could be that patients
in our series had less obstructing valves with onset of the renal impairment
later in life see table 6. We compared the pre-operative GFR of those who had
improved growth with those with regression in growth and it was 26.6
ml/min/l.73m2 and 32.75 ml/min/l.73m2. When we analysed
the GFR in the two groups by the WILCOXON's Rank Sum Test, P was 0.46 so
greater than the 5% level of probability (P > 0.05) indicating that the
difference in GFR in the two groups is statistically non-significant. Our
sample was probably too small to draw meaningful statistical conclusions from
the association body growth and GFR at diagnosis.
According to KRUEGER et al (15) growth failure is more
apparent with regard to linear growth but is also manifested as a failure to
gain weight. It is reported that a GFR of 25 to 30 ml/min/1.73m2 is
the threshold under which growth begins to be stunted, but this figure must be
considered a rough approximation, and some children continue to grow at their
centiles with a lower GFR (52).
Growth retardation is one of the most striking effects of
chronic renal failure in childhood (52). Among the factors that may interfere
with growth in children with renal insufficiency are nephrosis with massive and
permanent proteinuria entailing severe protein depletion, water and electrolyte
disturbances, hypertension, anaemia, renal osteodystrophy, hormonal and
metabolic disturbances and protein -energy malnutrition (52).
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