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Endocrinologic evaluation of children who grow poorly following renal transplantation
K L Jabs1, C Van Dop, W E Harmon
1Division of Nephrology, Children's Hospital, Boston, MA 02115.
Insights
Children with poor growth after kidney transplants often have abnormal growth hormone (GH) secretion. Evaluating GH levels can help identify growth failure causes in these pediatric patients.
Area of Science:
- Pediatric Nephrology
- Endocrinology
- Growth Disorders
Background:
- Successful renal transplantation in children does not always result in adequate growth.
- Growth failure is a significant concern in pediatric kidney transplant recipients.
Purpose of the Study:
- To investigate the prevalence and characteristics of growth hormone (GH) secretion abnormalities in pediatric renal transplant recipients experiencing poor growth.
Main Methods:
- Retrospective review of 25 pediatric renal transplant recipients with stable renal function.
- Comparison of growth patterns between well-growing and poorly growing children.
- Endocrinologic evaluation including measurement of plasma GH concentrations during sleep and after pharmacologic stimulation (arginine, L-DOPA) in children with poor growth.
Main Results:
- Children with poor growth showed more frequent elevated serum creatinine levels.
- Abnormal GH secretion was identified in a significant proportion of poorly growing children, with inadequate GH release during sleep and/or after stimulation.
- Renal insufficiency was present in all studied children, but thyroid hormones and IGF-I levels were normal.
Conclusions:
- Abnormalities in GH secretion are common in pediatric patients with poor growth post-renal transplantation.
- Assessing GH secretion is valuable for diagnosing growth failure in this population.
- Further investigation into the efficacy of GH therapy for these patients is warranted.
Abstract:
Some children do not grow well following successful renal transplantation. We reviewed 25 children with renal allografts who receive regular medical care in the renal transplant program at The Children's Hospital, were less than or equal to 18 years of age, and had stable renal function. We compared children who were growing well (n = 14) with those who were growing poorly (n = 11). The children with poor growth more frequently had elevated serum creatinine concentrations (8/11 vs. 3/14). The mean age at transplantation was the same, although the duration of follow-up was shorter for the children growing well (3.3 +/- 0.5 years) than for those growing poorly (6.2 +/- 1.0 years, P less than 0.02). Eight of the children who were growing poorly underwent endocrinologic evaluation. Plasma growth hormone (GH) concentrations were measured during sleep, after arginine and L-DOPA administration, and during a 4-hr oral glucose tolerance test. In 4 patients, the maximum GH concentration was inadequate both following pharmacologic stimulation (4.0 +/- 2.6 ng/ml, n = 4) and during sleep (4.4 +/- 0.2 ng/ml, n = 3). In 2 additional patients, maximal GH concentrations were subnormal during sleep despite adequate responses during pharmacologic stimulation. In the final two patients, GH secretion was adequate both during sleep and after stimulation. All children studied had some degree of renal insufficiency with a mean creatinine clearance of 39 +/- 4 ml/min/1.73 m2. Plasma concentrations of thyroxine, thyrotropin, and IGF-I were normal for age in all eight patients. We conclude that abnormalities in GH secretion occur frequently among patients who grow poorly following successful renal transplantation. Evaluation of GH secretion may be useful in evaluating growth failure in this group of patients, and the usefulness of GH therapy should be investigated.