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Longitudinal growth in chronic hypokalemic disorders

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Abstract

Growth retardation remains a major complication in children with primary tubular disorders, despite adequate supplemental treatment with electrolytes, water and bicarbonate. Chronic hypokalemia, characteristic of some tubulopathies, impairs growth by mechanisms that are not well known. Association with growth hormone deficiency has been reported in patients with Bartter’s or Gitelman’s syndrome. Tissue-specific alterations of growth hormone and insulin-like growth factor I axis have been described in experimental models of potassium depletion. Hypokalemic rats gain less body length and weight than pair-fed normokalemic animals and, by contrast, develop renal hypertrophy. These rats have low circulating concentrations of insulin-like growth factor I, depressed messenger ribonucleic acid (mRNA) levels of this peptide in the tibial growth plate, and they are resistant to the longitudinal growth-promoting effects of exogenous growth hormone. The reason for this resistance remains to be defined. No alterations in the intracellular signaling for growth hormone have been found in the liver of hypokalemic rats. However, treatment with high doses of growth hormone is unable to normalize hypertrophy of the epiphyseal cartilage chondrocytes, which are severely disturbed in potassium depletion and likely play an important role in the pathogenia of growth impairment in this condition.

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Acknowledgments

This work was supported by grant FIS 06/1730 and Fundación Nutrición y Crecimiento. It was completed during the sabbatical stay of N. Mejia from Hospital Universitario Fundación Santa Fé, Bogotá, Colombia. Presented in part at the 8th International Symposium on Growth and Nutrition in Children with Chronic Renal Disease, Oviedo, Spain, 28–30 May 2009.

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Authors and Affiliations

  1. Pediatric Nephrology, Hospital Universitario Central de Asturias, University of Oviedo, Oviedo, Asturias, Spain

    Helena Gil-Peña, Natalia Mejia, Oscar Alvarez-Garcia, Vanessa Loredo & Fernando Santos

  2. Area de Pediatria, Facultad de Medicina, c/ Julian Claveria 6, 33006, Oviedo, Asturias, Spain

    Fernando Santos

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  1. Helena Gil-Peña
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  2. Natalia Mejia
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  3. Oscar Alvarez-Garcia
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  4. Vanessa Loredo
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  5. Fernando Santos
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Correspondence to Fernando Santos.

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Gil-Peña, H., Mejia, N., Alvarez-Garcia, O. et al. Longitudinal growth in chronic hypokalemic disorders. Pediatr Nephrol 25, 733–737 (2010). https://doi.org/10.1007/s00467-009-1330-7

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