title: Modulation of growth factors by growth hormone in children with chronic renal failure. The Southwest Pediatric Nephrology Study Group.
abstract: Anthropometric measurements and circulating growth factors were studied serially in 44 prepubertal children with growth failure and chronic renal failure (GFR = 10 to 40 ml/min/1.73 m2) who were randomized to receive either recombinant human growth hormone (rhGH; N = 30) or no treatment (N = 14). RhGH was given as Nutropin, 0.05 mg/kg/day, and the studies were carried out at baseline and after 3 and 12 months. At baseline, serum insulin-like growth factor binding protein (IGFBP)-1 and -2 levels were, while IGFBP-3 levels were not, higher than those of children with normal renal function. In addition, height SDS at baseline correlated inversely with serum IGFBP-2 levels (r = -0.461, P = 0.0016), but did not correlate significantly with any other factor. After 12 months of study, the 30 children receiving rhGH showed: (i) greater increase in height (9.1 +/- 2.8 vs. 5.5 +/- 1.9 cm, P < 0.0001); (ii) increases in serum levels of IGF-I, IGF-II, free IGF-I, IGFBP-3 and acid labile subunit (ALS); (iii) a greater decrease in serum IGFBP-1 levels; and (iv) no significant difference in serum IGFBP-2 levels, when compared to the 14 control patients. The change in height SDS after 12 months of rhGH (+0.8) in the 30 treated children correlated significantly and positively with serum ALS, IGFBP-3, total IGF, IGF-I, IGF-II and free IGF-I levels measured during treatment. These observations suggest that, in children with growth failure associated with chronic renal failure: (i) IGFBP-2, and not IGFBP-3, is likely to be a growth inhibitor; (ii) rhGH stimulates catch-up growth in part by increasing serum levels of IGF peptides; and (iii) linear growth is influenced by the balance between growth stimulating IGFs and growth inhibitory IGFBPs.
authors.affiliation: Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA.
authors.forename: D R
authors.initials: DR
authors.lastname: Powell
authors.forename: F
authors.initials: F
authors.lastname: Liu
authors.forename: B K
authors.initials: BK
authors.lastname: Baker
authors.forename: R L
authors.initials: RL
authors.lastname: Hintz
authors.forename: P D
authors.initials: PD
authors.lastname: Lee
authors.forename: S K
authors.initials: SK
authors.lastname: Durham
authors.forename: E D
authors.initials: ED
authors.lastname: Brewer
authors.forename: J W
authors.initials: JW
authors.lastname: Frane
authors.forename: S L
authors.initials: SL
authors.lastname: Watkins
authors.forename: R J
authors.initials: RJ
authors.lastname: Hogg
mesh_terms: D000365:Age Determination by Skeleton; D000886:Anthropometry; D001827:Body Height; D002648:Child; D002675:Child, Preschool; D005260:Female; D006133:Growth Substances / Q000378:metabolism*; D019382:Human Growth Hormone / Q000627:therapeutic use*; D006801:Humans; D007328:Insulin / Q000097:blood; D018969:Insulin-Like Growth Factor Binding Proteins / Q000097:blood; D007334:Insulin-Like Growth Factor I / Q000032:analysis; D007335:Insulin-Like Growth Factor II / Q000032:analysis; D007676:Kidney Failure, Chronic / Q000188:drug therapy* / Q000378:metabolism* / Q000473:pathology; D008297:Male; D011994:Recombinant Proteins
chemical_list: D006133:Growth Substances; D007328:Insulin; D018969:Insulin-Like Growth Factor Binding Proteins; D011994:Recombinant Proteins; D019382:Human Growth Hormone; D007334:Insulin-Like Growth Factor I; D007335:Insulin-Like Growth Factor II