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Learning that your child has chronic renal insufficiency (a stage of chronic kidney disease, or CKD) can be stressful, both for your child and for you. You might not know what to expect, either in the near future or down the road.

As a parent, it’s natural to focus on your child’s kidney condition. But it’s also important to keep your child’s overall health in perspective, including the need to help him or her maintain growth. For that, it helps to understand chronic renal insufficiency (CRI) and its complications, some of which may affect your child’s ability to grow.

How growth hormone (GH) works in your body

Made by the pituitary gland in the brain, growth hormone helps the body produce muscle and break down fats. It also plays a critical role in helping young bodies grow and develop.

Most young people with CRI produce normal amounts of GH. The problem is, because so much waste is trapped in their blood, their bodies aren’t able to use growth hormone efficiently. That means

• Insulin-like growth factor (IGF) gets stopped along the way to muscles, organs, and bones
• Nutrients in food aren’t converted to muscle mass effectively
• Calcium, the main mineral that makes bones, gets drawn out of the bones and into the bloodstream

Even though children with CRI make plenty of GH, their growth may slow down. Without help, it’s unlikely they can catch up. Your healthcare professional may prescribe treatments to help your child grow.

How CRI happens

To understand what’s going on in your child’s body, it’s important to know what healthy kidneys do—and how chronic renal insufficiency (CRI) affects the way kidneys function.

The two kidneys, located on each side of the middle of the back, serve many purposes in a healthy body. They:

• Filter blood to get rid of excess fluid, minerals, and waste through urine
• Help maintain blood pressure and the right balance of chemicals and minerals in the body
• Help produce critical compounds like activated vitamin D (important to bone health) and erythropoietin (important to healthy blood)

CRI is a loss of kidney function over a period of months or years. If your child’s kidneys are damaged, they can start losing their ability to do their job as well as they should. That can throw your child’s body chemistry out of balance. As CRI progresses, blood pressure control becomes more difficult. In addition, it gets harder for the body to

• Make red blood cells
• Use nutrition from food efficiently
• Build muscles and bones
• Gain height

How GH may help

Your healthcare professional may recommend one or more therapies to help manage the effects of CRI. An important part of that is making sure your child continues to grow, particularly in the early years of life. The good news is, what you do may make a difference:

CRI may be managed:

• Treatments, such as dialysis, can help filter your child’s blood
• Certain medicines can help manage your child’s blood chemistry. Make sure your child takes as directed all the medicines his or her healthcare professional prescribes
• Healthy eating can go a long way—your healthcare team can help you establish and maintain a proper diet for your child

Because CRI may keep GH from working properly, healthcare professionals may prescribe GH to help treat GH failure associated with CRI. This therapeutic form of GH is the same protein your child makes naturally in his or her own body

• GH may help children get closer to reaching their growth potential

Healthy children reach about one-third of their adult height within their first two years of life. CRI can seriously interfere with growth, making it important to act as soon as a growth problem is diagnosed.

For children and teenagers with CRI, growth hormone therapy means taking regular injections of growth hormone (such as Nutropin) until you have a kidney transplant. Nutropin is the only growth hormone indicated for the treatment of growth failure associated with CRI up to the time of transplant. GH therapy with Nutropin can be one part of the overall strategy to optimize the treatment of your child’s CRI.

IMPORTANT SAFETY INFORMATION

Nutropin and your safety:
Please read this important safety information carefully. Then, if you have any questions, talk with your doctor.

Nutropin is NOT for:

• Children and teenagers whose bones have finished growing
• Patients who have certain types of eye disease caused by diabetes
• Patients who have active cancer or any brain tumors
• Patients who are critically ill after open heart surgery or abdominal (stomach) surgery, are severely hurt, or have severe breathing problems
• Children and teenagers who have Prader-Willi syndrome and are very overweight or have trouble breathing
• Patients with a known sensitivity to benzyl alcohol, an ingredient in the liquid used to mix Nutropin Injection. Sterile water should be used when mixing Nutropin for newborns.

If any of these apply, talk to your doctor before you start taking Nutropin.

If you are about to start taking Nutropin, or are already taking it, be sure to tell the doctor who prescribed it:

• About ALL of the medications you are taking, including supplements
• If you have or develop a brain tumor
• If you are given any new medication, especially glucocorticoid steroids like hydrocortisone or prednisone
• If you are pregnant or if you become pregnant
• About ANY other condition or illness you have or develop

What are the possible side effects of Nutropin?
You may experience discomfort, soreness, or redness where Nutropin is injected.

Contact your doctor immediately if you experience:

• Ongoing injection site discomfort
• Curvature of the spine (scoliosis)
• Joint pain
• Puffy hands and/or feet (caused by fluid retention)
• Changes in vision, a bad headache, or nausea with or without vomiting
• Hip or knee pain
• A need to limp when you walk
• Pain in wrist (carpal tunnel)
• Allergic reaction

Be sure to inject Nutropin at a different recommended place on your body each time. Your doctor or nurse should supervise the first injection and provide training and instruction.

Your doctor is your primary source of information about your treatment.

Please see the full Prescribing Information for Nutropin and Nutropin AQ, available from your pharmacy and at www.nutropin.com, for more about Nutropin and safety.

Questions? Call the Nurse Hotline at 1-866-NUTROPIN (1-866-688-7674).

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