Efficacy and safety of one year of growth hormone therapy in steroid-dependent nephrotic syndrome.
OBJECTIVE
To study the efficacy and safety of 1 year of growth hormone (GH) therapy in children with steroid-dependent nephrotic syndrome.


METHODS
A prospective pilot, open study in which GH (mean dose 0.32 mg/kg per week) was administered for 1 year to 8 children with steroid-dependent nephrotic syndrome requiring prednisolone (mean dose 0.46 mg/kg per day) to maintain remission. Steroid dependence was defined as recurrence of proteinuria within 2 weeks of discontinuation of prednisolone, or when the dose was lowered below a critical level. At entry, all patients had been steroid dependent for at least 1 year. Anthropometric and bone mineral density measurements after treatment were compared with 1-year pretreatment data.


RESULTS
Pretreatment mean (+/-SD) chronologic age was 12.6 (+/-3.1) years, with a mean bone age of 9.1 (+/-2.0) years, with delayed puberty in five patients. The mean height velocity increased from 3.7 (+/-1.4) to 9.4 (+/-2.1) cm/yr after 1 year of treatment (p < 0.05). The mean height standard deviation score increased from -1.4 (+/-1.6) to -0.3 (+/-1.1), (p < 0.05). In the spine, the mean bone mineral density increased from 0.50 to 0.64 gm/cm2 (p < 0.05), and in the femoral neck, from 0.55 to 0.64 gm/cm2 (p < 0.05) after 1 year of treatment. Mean lean body mass increased from 58.1% to 62.6% (p < 0.01). There were no significant changes in creatinine clearance, fasting glucose, fasting insulin, or glycosylated hemoglobin levels. The mean bone age increased to 11.4 (+/-2.4) years, and pubertal stage advanced in 2 patients.


CONCLUSIONS
One year of GH therapy is effective in improving the height standard deviation score, height velocity, bone mineral density, and lean body mass of children with steroid-dependent nephrotic syndrome. There were no significant adverse effects. However, the bone age accelerated at a greater pace than the height age, and further studies are required to define the role of GH therapy in steroid-dependent nephrotic syndrome.
Loke
K Y
KY
Department of Pediatrics, National University of Singapore, Singapore.
Yap
H K
HK
Zhou
X
X
Tan
S P
SP
Chao
S M
SM
Lee
K O
KO
D000293:Adolescent; D000886:Anthropometry; D001786:Blood Glucose; D001827:Body Height / Q000187:drug effects; D015519:Bone Density; D002648:Child; D004359:Drug Therapy, Combination; D005260:Female; D013006:Growth Hormone / Q000627:therapeutic use*; D006801:Humans; D007334:Insulin-Like Growth Factor I / Q000378:metabolism; D008297:Male; D009404:Nephrotic Syndrome / Q000188:drug therapy*; D010865:Pilot Projects; D011239:Prednisolone / Q000627:therapeutic use*; D011446:Prospective Studies; D011628:Puberty, Delayed / Q000188:drug therapy
D001786:Blood Glucose; D007334:Insulin-Like Growth Factor I; D013006:Growth Hormone; D011239:Prednisolone