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Changes in bone mineral density, growth velocity and renal function of prepubertal uremic children during growth
1Unidad de Endocrinologia Pediatrica, Hospital de Clinicas Caracas, Venezuela.
Insights
Recombinant human growth hormone (rhGH) significantly improved growth and bone mineral density in prepubertal children with chronic renal failure. Careful monitoring of renal function is essential during treatment.
Area of Science:
- Pediatric Nephrology
- Endocrinology
- Metabolic Bone Disease
Background:
- Children with chronic renal failure often experience growth failure and reduced bone mineral density.
- Recombinant human growth hormone (rhGH) is a potential therapeutic option for these complications.
Purpose of the Study:
- To evaluate the efficacy of rhGH in improving growth and bone mineral density in prepubertal children with severe chronic renal failure.
- To assess the safety and impact of rhGH on renal function in this patient population.
Main Methods:
- Thirteen prepubertal children with severe chronic renal failure received rhGH (1 IU/kg/week) subcutaneously for 12 months.
- Growth rates, height standard deviation scores (SDS), and bone mineral density were assessed.
- Renal function markers (serum creatinine, BUN, GFR) were monitored throughout the study.
Main Results:
- Mean growth rates increased significantly from 4.3 to 9.1 cm/year.
- Mean height SDS improved from -3.5 to -2.6.
- Bone mineral content and density (cortical and trabecular) increased significantly, reaching levels comparable to age-matched healthy controls.
- Renal function remained stable in most patients, though two required treatment discontinuation due to deterioration.
Conclusions:
- rhGH treatment significantly enhances growth velocity and bone mineral density in prepubertal children with chronic renal failure.
- rhGH offers a promising therapeutic strategy for improving linear growth and bone health in this population.
- Close monitoring of renal function is crucial during rhGH therapy to manage potential adverse effects.
Abstract:
Thirteen prepubertal children with a mean chronological age of 6.7 +/- 3.4 years and severe chronic renal failure (mean glomerular filtration rate of 20.8 +/- 17.7 ml/min/1.73 m2) were studied. Patients received recombinant human growth hormone (rhGH) at a dose of 1 IU/kg/week given subcutaneously on a daily basis for 12 months. Mean growth rates of our patients increased significantly from a baseline level of 4.3 +/- 2.1 to 9.1 +/- 2.0 cm/year at 12 months of rhGH therapy. Mean height SDS improved from -3.5 +/- 1.0 at initiation of therapy to -2.6 +/- 1.3 at 12 months. Mean serum creatinine and blood urea nitrogen levels remained stable during the study, while mean glomerular filtration rates decreased initially and then stabilized; however, 2 subjects had a significant deterioration of their renal function at 6 and 9 months of rhGH, requiring discontinuing treatment. Before rhGH treatment, total bone mineral content as well as bone mineral density in cortical and trabecular bone were significantly reduced in our patients when compared to healthy controls paired for chronological age and similar to those of a healthy control group paired for bone age and height. Both these parameters increased significantly during rhGH treatment so that at 12 months our patients had values similar to those seen in a healthy control population paired to our patients for chronological age. While trabecular bone mineral density did not change in a group of untreated uremic controls during 12 months of follow-up, the percent of bone mineral density change in trabecular bone in our uremic patients during 12 months of rhGH treatment was very significant (p < 0.001) and larger than that noted in a group of healthy controls paired for bone age and height during 12 months of follow-up. This study demonstrates how rhGH treatment in prepubertal uremic children increases their growth velocity and their bone mineral density significantly, with an improvement in height for age. Careful followup of the renal function of patients in needed as they improve their height and bone mineral status.