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[Indications for recombinant growth hormone (rhGH) treatment in kidney diseases]
D Colombo1, L Ghio, F Marchesi
1Clinica Pediatrica II, Università di Milano, Italia.
Insights
Recombinant human growth hormone (rhGH) effectively treats growth retardation in children with chronic kidney disease, improving height and nutritional status. Treatment is most beneficial for prepubertal children and during the first year of therapy.
Area of Science:
- Pediatric Nephrology
- Endocrinology
- Growth Disorders
Background:
- Children with chronic kidney disease often experience growth retardation due to altered growth hormone-insulin-like growth factor axis.
- Uremia leads to peripheral resistance in the growth hormone-insulin-like growth factor axis.
Purpose of the Study:
- To evaluate the efficacy of recombinant human growth hormone (rhGH) in improving growth and nutritional status in children with renal failure.
- To provide guidelines for rhGH treatment in renal diseases.
Main Methods:
- Review of experimental and clinical studies on rhGH treatment in pediatric renal failure.
- Analysis of growth velocity, height standard deviation score, nitrogen balance, and body composition.
Main Results:
- rhGH significantly increases growth velocity and height standard deviation score in prepubertal children with chronic renal failure.
- rhGH improves nitrogen balance, increases muscle mass, and decreases fat mass.
- Treatment benefits are most pronounced in prepubertal patients and during the first year of therapy.
Conclusions:
- rhGH is a safe and effective treatment for growth retardation in children with chronic renal failure.
- rhGH has potential applications in improving hypercatabolic conditions associated with acute renal failure.
- Guidelines for rhGH use in renal diseases are discussed.
Abstract:
Growth retardation is one of the major problem in children with chronic and terminal renal failure. The growth hormone-insulin-like growth factor axis is altered in uraemia, resulting in peripheral resistance. This insensitivity seems to be overcome in an experimental study by supraphysiological doses of recombinant human growth hormone (rhGH). Several clinical studies have confirmed that rhGH increases growth velocity in children with chronic renal failure with and without dialysis and after renal transplant, without significant side-effects. The improvement of growth is more marked in prepubertal patients and during the first year of rhGH treatment. Also in our experience prepubertal children showed an increase of height standard deviation score and growth velocity during rhGH treatment; the pubertal patients failed to improve their statural growth. GH, as the prototype of an anabolic hormone, has also great potential in improving catabolic conditions of various origin, particularly those due to renal failure. RhGH can improve nitrogen balance and the nutritional parameters with an increase of muscle mass and a decrease of fat mass. Prospectively, rhGH could be utilized to improve the hypercatabolic condition of acute renal failure. The following analysis will discuss the recent studies employing rhGH in renal diseases and will attempt to give some guide lines to rhGH treatment in these illnesses.