GROWTH HORMONE (GH) TREATMENT OF CHILDREN WITH CHRONIC RENAL FAILURE (CRF) AFTER RENAL TRANSPLANTATION (Tx)

Abstract

Children with CRF grow poorly and, frequently, neither dialysis nor Tx improve growth. It has been proposed that these children have target organ resistance to the effects fo GH/IGF-I which could be overcome by supraphysiological doses of GH. Our objective was to evaluate growth response and renal function after GH treatment (1 IU/Kg. week) in patients with CRF after Tx. Seven patients (5 prepubertal and 2 pubertal children) were studied: mean ± SD chronological age (A) 12.2±3.25 years (y), bone A 8.47±3.94 y, height SDS −3.82±1.44 and post Tx time 1.99±2.16 y. All patients had normal serum T4 and T3 levels and GH responses to pharmacological tests (> 7 ng/ml). Mean GH treatment time was 7.0±3.46 moths. Parameters of biological actions of GH (growth velocity : GV, serum levels of SHBG and IGF-1) and of renal function (Cr cl) were evaluated before and after treatment. Findings were as follows: a significative increment in GV (from 2.46±0.63 to 7.42±1.68 cm/y, p< 0.001, ANOVA), similar CrCI (96.2±12.9 and 100.6±25.8 ml/min. 1.73m ), a significant decrement in serum SHBG (from 75.9±32.4 to 55.5±31.5 nmol/L, p<0.01) and a non significant increment in serum IGF-I (from 220± 66.5 to 305±142.5 ng/ml). It is concluded that GH treatment at supraphysiological doses in CRF patients after TX does increase GV without changing functions parameters of the transplanted kidney. Serum SHBG is a biological response parameter to GH.

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