Stunted growth is a serious problem for many children with chronic renal insufficiency (CRI). Dialysis does not improve growth velocity, while renal transplantation does not always result in better growth either. The pathogenesis of the growth retardation is unknown, but growth hormone (GH) secretion and plasma levels of insulin-like growth factors (IGF) I and -II appear to be normal. Elevated levels of IGF-binding proteins may be involved in the growth retardation. Several 2-year studies have shown that impressive increase in growth velocity can be achieved with GH therapy with 28 IU/m2/week, without significant changes in renal function or adverse events. A lower GH dose of 14IU/m2/week was not able to maintain catch-up growth for longer than 6 months in children older than 4 years. Bone maturation appears unaffected, suggesting improved final height. In children with CRI GH-treatment is best started following 1 year of marked growth retardation. Preliminary results of GH-treatment in children after renal transplantation seem promising, but long-term data are needed before definitive conclusions can be drawn.