Growth Hormone in Children with Chronic Renal Insufficiency and Endhyphen;Stage Renal Disease

摘要

Long-term (5 years) hGH treatment in children with chronic renal insufficiency (CRI) produces sustained improvement in standardized height. hGH treatment of infants (2 1/2 years of age) with CRI is as effective at improving growth velocity as in older children with CRI. Once target height (50th percentile for midparental height) is reached, the optimal approach is to pause hGH treatment and observe the patient. If standardized height declines significantly, hGH is effective when re-initiated. Neither short-term or long-term hGH treatment in children with CRI or in pediatric allograft recipients adversely affects carbohydrate tolerance; however, hyperinsulinemia develops, which has not been associated with any clinical consequences to date. The presence of renal osteodystrophy may blunt the impact of hGH and predispose to development of slipped capital femoral epiphysis and/or avascular necrosis in children with CRI. Pretreatment radiologic evaluation and radiologic surveillance with clinical symptoms is indicated. hGH is effective during the initial year of treatment; however, the response may be blunted during the subsequent years of treatment.The precise mechanism of the latter has not been delineated. hGH has been shown to improve growth velocity in patients undergoing both peritoneal and hemodialysis; however, long-term data are lacking, and the response may be less than that achieved in patients with CRI. Growth velocity is uniformly improved in growth-retarded pediatric renal allograft recipients receiving hGH. Allograft dysfunction occurs after hGH treatment; however, the relationship to hGH treatment requires delineation. The mechanism responsible for early allograft dysfunction, which is usually reversible on discontinuation of hGH, is unknown. Risk factors for the development of an acute rejection episode during the course of hGH treatment are 1 prior rejection episode and the use of alternate day corticosteroid therapy. The potential exists for an accelerated decline in allograft function after hGH treatment in recipients with chronic rejection. The salutary effect of hGH in this patient population is probably related to increasing the bioavailability of (ldquo;freerdquo;) IGF-I.