Growth in children with chronic renal failure and after renal transplantation

Cephalometric craniofacial features of growing patients with chronic renal failure

INTRODUCTION

Chronic renal failure (CRF) in growing children can affect their physical growth status. The objective of this research was to study the craniofacial morphology of children with CRF as evaluated by cephalometric analysis.

METHODS

Twenty-three growing children with CRF were included in this study. They were divided into three groups according to age ranges. The age ranges were >5-11 (group 1); >11-14 (group 2); >14-16 (group 3). Another twenty-three matching controls (in age and gender) were also included. Lateral cephalometric radiographs were taken as part of these children's orthodontic records. Lateral cephalometric radiographs were corrected for magnification distortion, digitized, and cephalometric analysis was performed. Data were analysed using ANOVA test.

RESULTS

The results showed that CRF patients in all age groups have statistically significantly decreased posterior cranial base lengths. Posterior facial heights showed a significant decrease in CRF patients in groups 1 and 2. Younger CRF patients (group 1) showed statistically significant increased gonial angle and FH-Mandibular plane angle, SN-Mandibular plane angle and decreased posterior to anterior face height ratio, total anterior facial height (N-Me), Mandibular body length (Go-Me), upper anterior facial height (N-ANS), Y axis length, pterygomaxillary-A point length.

CONCLUSION

Younger children (groups 1 and 2) with CRF showed a decrease in posterior facial growth (posterior facial height and posterior cranial base) when compared to matching normal controls. This decrease is not significant in older group (group 3). This finding suggests that children with CRF might catch up in growth with normal subjects and most of the earlier retarded growth features disappear with age.

A case of anemia caused by combined vitamin B12 and iron deficiency manifesting as short stature and delayed puberty

Anemia caused by vitamin B12 deficiency resulting from inadequate dietary intake is rare in children in the modern era because of improvements in nutritional status. However, such anemia can be caused by decreased ingestion or impaired absorption and/or utilization of vitamin B12. We report the case of an 18-year-old man with short stature, prepubertal sexual maturation, exertional dyspnea, and severe anemia with a hemoglobin level of 3.3 g/dL. He had a history of small bowel resection from 50 cm below the Treitz ligament to 5 cm above the ileocecal valve necessitated by midgut volvulus in the neonatal period. Laboratory tests showed deficiencies of both vitamin B12 and iron. A bone marrow examination revealed dyserythropoiesis and low levels of hemosiderin particles, and a cytogenetic study disclosed a normal karyotype. After treatment with parenteral vitamin B12 and elemental iron, both anemia and growth showed gradual improvement. This is a rare case that presented with short stature and delayed puberty caused by nutritional deficiency anemia in Korea.