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Improvement of uremic growth failure by recombinant human growth hormone
B Tönshoff1, O Mehls, A Schauer
1Division of Pediatric Nephrology, University Children's Hospital, Heidelberg, Federal Republic of Germany.
Insights
Recombinant human growth hormone (rhGH) therapy significantly improved growth rates in prepubertal children with end-stage renal failure. rhGH treatment also increased growth factors without adverse effects on glucose or insulin levels.
Area of Science:
- Pediatric Nephrology
- Endocrinology
- Growth Hormone Therapy
Background:
- Children with end-stage renal failure often experience growth stunting.
- Growth hormone deficiency or resistance can contribute to poor growth in these patients.
Purpose of the Study:
- To evaluate the efficacy and safety of recombinant human growth hormone (rhGH) in prepubertal children with end-stage renal failure.
- To assess the impact of rhGH on growth velocity, serum IGF-I, IGF-II, and glucose metabolism.
Main Methods:
- Nine prepubertal children with end-stage renal failure received supraphysiological doses of rhGH (4 U/m2/day s.c.) for 6-9 months.
- Growth velocity, serum somatomedin bioactivity, insulin-like growth factor (IGF) I and II levels, glucose tolerance, and insulin levels were monitored.
- rhGH pharmacokinetics and antibody formation were also assessed.
Main Results:
- rhGH significantly improved mean height velocity standard deviation scores (SDS) from -2.8 to +2.5.
- Serum somatomedin bioactivity and basal IGF-I levels increased significantly.
- Elevated basal IGF-II levels were further increased; glucose tolerance and insulin levels remained stable.
- No rhGH antibodies were detected, and the pharmacokinetic profile in uremia was similar to the non-uremic state.
Conclusions:
- Short-term rhGH therapy is effective in improving growth rate in stunted prepubertal children with end-stage renal failure.
- The treatment appears safe, with no significant adverse effects on glucose metabolism or antibody formation.
- Longer-term studies are needed to determine the effect of rhGH on final adult height prognosis.
Abstract:
Nine stunted prepubertal children with end-stage renal failure were treated by rhGH in supraphysiological doses (4 U/m2/day s.c.) for a period of six to nine months. The six-month data from these children indicated that exogenous rhGH significantly improved the growth rate in all children (mean height velocity SDS before therapy, -2.8; during the treatment period, +2.5). This effect was accompanied by a significant increase in serum somatomedin bioactivity. Low normal basal serum IGF I concentrations were increased by rhGH. Elevated basal serum IGF II concentrations were further increased by rhGH treatment. The pharmacokinetic profile of rhGH in uremia resembles that of the non-uremic state; no accumulation was seen after 14 days of treatment. Glucose tolerance did not change, and insulin levels remained stable throughout the six-month observation period. No rhGH antibodies were detected. Although these short-term results are very encouraging, the effects of rhGH on the prognosis for final height need to be assessed over a longer period of time.