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Effects of growth hormone on kidney function in pediatric transplant recipients
B M Chavers1, L Doherty, T E Nevins
1Department of Pediatrics, University of Minnesota Medical Center, Minneapolis 55455, USA.
Insights
Recombinant human growth hormone (rhGH) treatment in children post-kidney transplant may lead to adverse renal events. This study observed increased serum creatinine and decreased kidney function, with some patients experiencing acute rejection or graft loss.
Area of Science:
- Pediatric Nephrology
- Endocrinology
- Transplantation Immunology
Background:
- Recombinant human growth hormone (rhGH) is considered for growth promotion in children with short stature post-kidney transplant.
- Previous evidence suggested potential benefits for growth rate in this population.
- The safety and renal impact of rhGH in pediatric kidney transplant recipients require further investigation.
Purpose of the Study:
- To prospectively evaluate the effects of rhGH treatment on renal function and acute rejection episodes in children following a successful kidney transplant.
- To assess changes in serum creatinine levels and calculated glomerular filtration rate (GFR) during rhGH therapy.
Main Methods:
- A prospective study involving eight children (mean age 11.6 years) who received daily rhGH treatment (0.04-0.05 mg/kg).
- Renal function was monitored by serum creatinine levels and calculated GFR.
- Acute rejection episodes and graft survival were recorded over a mean follow-up of 20 months.
Main Results:
- Seven patients completed at least 12 months of rhGH treatment.
- A trend towards increased mean serum creatinine (1.3 to 3.4 mg/dl) and decreased mean GFR (58 to 38 ml/min/1.73 m2) was observed, though not statistically significant (P=0.06 and P=0.08, respectively).
- Two patients experienced acute rejection, and three lost their grafts, returning to dialysis.
Conclusions:
- Preliminary findings suggest potential untoward renal events associated with rhGH treatment in children after kidney transplantation.
- Further research is warranted to understand the risks and benefits of rhGH in this vulnerable pediatric population.
- These observations highlight the need for careful monitoring of renal function and rejection in kidney transplant recipients receiving rhGH therapy.
Abstract:
Recent evidence suggests that treatment with recombinant human growth hormone (rhGH) after a successful kidney transplant improves the growth rate of children with short stature. We prospectively investigated eight children (6 boys, 2 girls), focusing on acute rejection episodes and changes in serum creatinine levels during rhGH treatment. The children (mean age 11.6 +/- 3.4 years) received rhGH daily (0.04-0.05 mg/kg subcutaneously). Seven patients completed at least 12 months (20 +/- 8 months) of rhGH treatment. Their mean serum creatinine level was 1.3 +/- 0.7 mg/dl 12 months before, and increased to 3.4 +/- 4.2 mg/dl after 12 months of rhGH treatment, but did not achieve statistical significance (P = 0.06). Their mean calculated glomerular filtration rate was 58 +/- 20 ml/min per 1.73 m2 12 months before, and decreased to 38 +/- 21 ml/min per 1.73 m2 after 12 months of rhGH treatment, but did not achieve statistical significance (P = 0.08). Of the seven patients, two developed acute rejection after 5 and 6 rejection-free years; three lost their grafts and returned to dialysis. These preliminary observations describe untoward renal events in children receiving rhGH treatment after a kidney transplant.