title: Growth failure associated with sirolimus: case report.
abstract: An 11-year-old girl, who was a renal transplant recipient, developed linear growth failure associated in time with sirolimus (SRL) treatment. After 5 years of functional graft [creatinine clearance (CCr) 90 ml/min per 1.73 m(2) body surface area], she developed acute renal failure due to calcineurin inhibitor-related hemolytic uremic syndrome, and cyclosporine A was replaced by SRL. Before the drug change, she had been growing normally (5.5 cm/year) and had reached the 33.9 percentile (P) of height (z-height -0.41), similar to her target. Two years later, her height had decreased to P 6th (z-height -1.54), as her growth velocity had diminished to 2.2 cm/year, despite optimal renal function (CCr 68 ml/min per 1.73 m(2)). Human recombinant growth hormone was needed to promote her catch-up growth and achieve the P 49th of height (z-height -0.03). SRL may have deleterious effects on growing children due its characteristic anti-proliferative and anti-angiogenic properties. Pediatric transplant recipients' linear growth should be cautiously monitored while they are being given SRL.
authors.affiliation: Division of Pediatric Nephrology, Hospital de Cruces, Baracaldo, Vizcaya, Spain.
authors.forename: Gloria A
authors.initials: GA
authors.lastname: Rangel
authors.forename: Gema
authors.initials: G
authors.lastname: Ariceta
mesh_terms: D001827:Body Height / Q000187:drug effects*; D002648:Child; D016572:Cyclosporine / Q000627:therapeutic use; D005260:Female; D006084:Graft Rejection / Q000517:prevention & control; D019382:Human Growth Hormone / Q000627:therapeutic use; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D007676:Kidney Failure, Chronic / Q000601:surgery; D016030:Kidney Transplantation; D020123:Sirolimus / Q000009:adverse effects*
chemical_list: D007166:Immunosuppressive Agents; D019382:Human Growth Hormone; D016572:Cyclosporine; D020123:Sirolimus