The kidney and IGF-1 axis as a central regulator of linear growth and adult height in pediatric health and disease.

The kidney plays an important role in normal linear growth throughout childhood by regulating systemic insulin-like growth factor-1 (IGF-1) bioavailability through the filtration and processing of IGF-binding proteins and by serving as a target organ for growth hormone (GH). In pediatric chronic kidney disease (CKD), impaired renal function is associated with reduced availability of bioactive IGF-1 despite normal or modestly elevated total IGF-1 concentrations, reflecting altered binding protein dynamics and functional GH-IGF resistance. These changes are frequently accompanied by impaired growth velocity and reduced height, particularly in advanced CKD stages. This review synthesizes experimental and observational evidence examining the role of the kidney and IGF-1 axis in physiological linear growth and CKD-related growth failure. Observational studies demonstrate consistent associations between renal volume, IGF-1 parameters, and height outcomes. Across CKD stages, progressive reductions in free IGF-1 parallel worsening renal function and growth impairment. Recombinant human GH therapy improves growth velocity and may help children achieve near-adult height closer to their genetic potential when initiated early and appropriately monitored. Collectively, these findings support a renal-endocrine model of pediatric growth regulation in health and disease.