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Treatment of short stature in renal disease with recombinant human growth hormone
1Children's Renal Unit, Evelina Children's Hospital, London.
Insights
Recombinant human growth hormone treatment significantly increased growth velocity in children with chronic kidney disease and after renal transplants. However, it did not improve height SD scores, and long-term effects remain unknown.
Area of Science:
- Pediatric Nephrology
- Endocrinology
- Growth Disorders
Background:
- Children with chronic renal failure or post-renal transplant often experience short stature and poor growth.
- Growth hormone deficiency can be a contributing factor to growth impairment in these pediatric populations.
Purpose of the Study:
- To evaluate the efficacy of recombinant human growth hormone (rhGH) in improving growth velocity and height in prepubertal and pubertal children with renal failure or post-renal transplant.
- To assess the safety and impact of rhGH on renal function in this cohort.
Main Methods:
- A study involving three groups of children: prepubertal with chronic renal failure, prepubertal post-renal transplant, and pubertal post-renal transplant.
- All participants were short and exhibited poor growth; they received rhGH (30 units/m2/week) for approximately one year.
- Growth velocity and height SD scores were monitored throughout the treatment period. Renal function was also assessed.
Main Results:
- Treatment with rhGH led to a significant increase in growth velocity across all three groups.
- No significant improvement in height SD score for bone age was observed in any group.
- Two children experienced renal function deterioration, though a causal link to rhGH was not established.
Conclusions:
- Recombinant human growth hormone effectively enhances growth velocity in children with kidney disease and post-transplant.
- rhGH did not improve bone age-adjusted height in the studied groups.
- Further research is needed to determine the long-term effects and final height outcomes of rhGH treatment in pediatric kidney disease patients.
Abstract:
Six prepubertal children with chronic renal failure (group 1), six prepubertal children with renal transplants (group 2), and six pubertal children with renal transplants (group 3) who were short (mean height SD score, -3.2, range -4.5 to -1.6) and growing poorly (mean (range) growth velocity (cm/year) over the year before treatment: group 1, 4.8 (3.5-5.8), group 2, 2.3 (0.9-4.7), and group 3, 3.2 (0.5-6.5] were treated with recombinant human growth hormone 30 units/m2/week in daily doses for a median of 0.98 years (range 0.25-0.99). Mean (range) growth velocity over the treatment period increased significantly in all groups (group 1, 10.7 (8.8-12.3), group 2, 6.1 (2.7-10.8), and group 3, 6.0 (4.6-6.8]. There was, however, no improvement in height SD score for bone age in any group. The renal function of two children deteriorated after starting treatment with growth hormone, but it was not possible to say whether the growth hormone was responsible for this. The long term effects of treatment and its influence on final height are not yet known.