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Treatment of growth failure in children after renal transplantation
M R Benfield1, K L Parker, F B Waldo
1Division of Pediatric Nephrology, University of Alabama, Birmingham 35233.
Insights
Recombinant human growth hormone (rhGH) significantly improved height velocity and growth in children with renal failure post-transplantation. This treatment offers a potential solution for growth failure in pediatric kidney transplant recipients.
Area of Science:
- Pediatric Nephrology
- Endocrinology
- Growth Hormone Therapy
Background:
- Growth failure is a significant challenge in children with renal failure, persisting even after successful kidney transplantation.
- Limited
- catch-up
- growth and attainment of normal adult height are common issues post-transplant.
Purpose of the Study:
- To evaluate the safety and efficacy of recombinant human growth hormone (rhGH) in improving growth in children experiencing growth failure after renal transplantation.
- To assess growth parameters, bone age, and renal function following rhGH treatment.
Main Methods:
- An open-label pilot study involving eleven children with growth failure post-renal transplantation.
- Daily subcutaneous administration of rhGH (0.05 mg/kg) for at least one year.
- Monitoring of height velocity, standard deviation score, Tanner stage, bone age, and creatinine clearance.
Main Results:
- Significant increase in height velocity (5.2 to 8.4 cm/year) and improvement in standard deviation score (-3.18 to -2.23).
- Treatment led to advancement in Tanner stage (1 to 2.8) and bone age (8.4 to 10.9 years).
- A non-statistically significant decrease in creatinine clearance was observed.
Conclusions:
- Supraphysiologic doses of rhGH demonstrate improved growth in children with functioning renal allografts.
- rhGH therapy is a promising intervention for addressing growth failure in pediatric kidney transplant recipients.
- Further research is warranted to monitor long-term effects on renal function.
Abstract:
Growth failure continues to be a problem in the management of children with renal failure. Children have improved growth after successful renal transplantation, but seldom have "catch-up" growth, or normal adult height. In this study we report the findings of an open label pilot study to determine the safety and efficacy of the use of recombinant human growth hormone (rhGH) in children with growth failure after successful renal transplantation. Eleven children completing at least 1 year of treatment had a mean age of 11.5 years (+/- 3.3) and mean bone age of 8.4 years (+/- 2.4), and were significantly growth-retarded (mean standard deviation score of -3.18 [+1.1]). After receiving rhGH (0.05 mg/kg) subcutaneously each day the height velocity increased from 5.2 cm/year to 8.4 cm/year (P = 0.003), and the standard deviation score improved from -3.18 to -2.23 (P = 0.004). Treatment was associated with advancement in Tanner stage from 1 to 2.8 (P = 0.004), increased bone age from 8.4 years to 10.9 years (P = 0.0002), and although it was not at the point of statistical significance, moderate decrease in creatinine clearance from 75 ml/1.73m2/min to 60 ml/1.73m2/min (P = 0.1). The advancement in Tanner stage and bone age was not out of proportion to the advancement in height age. These data suggest that children with functioning renal allografts have improved growth with supraphysiologic doses of rhGH.