Extraskeletal Disorders
Sickle Cell Anemia
Sickle cell anemia has been discussed earlier in this chapter. The reader is referred to outside references for additional discussion as needed.
Chronic Kidney Disease
Children with chronic kidney disease (CKD) are at great risk for short stature.
Adequate nutrition may be problematic. With failing kidneys, erythropoietin production is inadequate and anemia may result. These children may be resistant to their own elevated growth hormone (GH) and may require recombinant human GH subcutaneously (363). Renal osteodystrophy is a term that describes the bone disorder spectrum in CKD. It is most commonly associated with a high turnover bone disease secondary to hyperparathyroidism (363). Osteitis fibrosa cystica is the pathologic skeletal finding in this condition. The excessive parathyroid hormone is a response to correct the hypocalcemia by increasing the bone resorption (363). Clinically, these patients have muscle weakness, bone pain, and fractures from minor trauma. Rachitic changes as well as varus and valgus deformities of the long bones and slipped capital femoral epiphyses may be seen in growing children. The x-rays demonstrate subperiosteal resorption and widening of the metaphyses in the hands, wrists, and knees (363). Medical management for this condition is by a nephrologist. Diets include low phosphorus, phosphate binders, vitamin D, and non-calcium- based diets for those who are prone to hypercalcemia. Recombinant human erythropoietin subcutaneously and iron orally or intravenously are important treatments for anemia (363).
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