[Growth hormone treatment before and after renal transplantation].
Children with chronic renal disease may improve height with growth hormone (GH) treatment. We studied 2 groups of children with height below 1.8 SDS and/or height velocity (HV) below the 3rd centile: 1) 6 patients with end stage renal disease (ESRD) on dialysis, aged 12.2 +/- 4.4 years (x +/- sd), with bone age of 6.8 +/- 3.3 years, 3 with Tanner stage I and 3 Tanner II; and 2) 6 children with functioning renal transplants, aged 15.5 +/- 2.5 years, with bone age 10.0 +/- 2.3 years, Tanner II-IV. Maintenance dosage of orally administered methylprednisone (MP) was 0.16 +/- 0.04 mg/kg/day. 1) Children with ESRD received GH during 1 to 3.5 years. Height SDS and HV (x +/- sd) were: pre GH -3.8 +/- 0.6 SDS and 2.6 +/- 1.4 cm/y; at 1 year of GH therapy (n = 6) -3.9 +/- 0.4 SDS and 5.1 +/- 3.2 cm/y; at 2 years (n = 5) -4.2 +/- 0.5 SDS and 3.1 +/- 0.7 cm/y; at 3 years (n = 4) -4.1 +/- 0.7 SDS and 3.3 +/- 1.5 cm/y. Height SDS and HV were: pre GH -3.0 +/- 1.9 SDS and 3 +/- 1 cm/y; at 1 year -2.5 +/- 1.5 SDS (p < 0.05) (t paired test) and 6.9 +/- 2.3 cm/y (p < 0.01). Height SDS and HV increased; creatinine clearance remained stable; there was correlation between height SDS and serum creatinine r = -0.81, creatinine clearance and HV r = 0.92, MP dose and HV r = -0.85. Five of 6 patients reached adult height of -2.8 +/- 1.3 SDS, below their target height of -0,3 +/- 0.7 SDS (p < 0.005).


CONCLUSIONS
In patients with ESRD, GH therapy did not improve significantly height SDS and HV. In pubertal transplanted patients height SDS and HV improved and renal function remained stable; final height remained below expected genetic height. Prolonged periods of GH therapy are necessary to evaluate if final height can be improved with GH.
Sección Endocrinología, Hospital Italiano, Buenos Aires. tpasqualin@intramed.net.ar
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Pasqualini
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Ferraris
D000293:Adolescent; D002648:Child; D005260:Female; D006130:Growth Disorders / Q000188:drug therapy*; D019382:Human Growth Hormone / Q000627:therapeutic use*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000188:drug therapy / Q000601:surgery*; D016030:Kidney Transplantation; D008297:Male; D011184:Postoperative Period; D006435:Renal Dialysis
D019382:Human Growth Hormone