Article

Growth hormone treatment of renal growth failure during infancy and early childhood

Department of Paediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, Carl Neuberg Str. 1, 30625, Hanover, Germany.
Pediatric Nephrology (Impact Factor: 2.86). 05/2009; 24(6):1093-6. DOI: 10.1007/s00467-009-1190-1
Source: PubMed

ABSTRACT

Despite major progress in dialysis, nutrition and drug treatment in the past 20 years, growth of infants and toddlers with chronic kidney disease (CKD) remains a major challenge in paediatric nephrology. Our hypothesis is that early growth deficit is one of the most important factors for impaired final height in children with CKD, and we conclude that early implementation of recombinant human growth hormone (rhGH) therapy should be offered to infants with growth failure. Infants with delayed growth, adequate caloric intake and stable parameters of bone metabolism are candidates for rhGH therapy. One predictive factor for the selection of infants for rhGH treatment may be growth retardation at birth. Our conclusion from the limited published data is that the use of rhGH in young children with CKD is effective and safe. Compared with its use in older children, the early use of growth hormone requires lower absolute dosages of rhGH, which therefore reduce the annual treatment costs and allow earlier renal transplantation. Furthermore, an early start on rhGH improves the psychosocial situation later in childhood and may lead to a further improvement in adult height. A multi-centre randomised controlled study should be initiated to analyse the short-term and long-term effects of early rhGH therapy on infants with CKD.

Download full-text

Full-text

Available from: Doris Franke
  • Source
    • "Results of functional GH tests depend on the assay used, the pubertal and nutritional state of the child, and the GH secretion pattern before the test. These tests are difficult to reproduce[23]. Although there is great similarity between the amounts of IGF-I and IGFBP-3 in GHD children when compared to normal children, these measurements are reasonably specific and useful if combined with other diagnostic criteria. "

    Full-text · Article · Jan 2016 · Open Journal of Endocrine and Metabolic Diseases
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Although results of renal replacement therapy (RRT) in small children have improved during recent years, data about RRT in neonates are scarce. In a retrospective study, we analyzed the outcome of infants who had chronic kidney disease and started RRT within their first year of life. Between 1997 and 2008, all 29 infants who were younger than 1 yr, had end-stage renal failure, and underwent RRT (dialysis or transplantation) at Hannover Medical School were analyzed for up to 12 yr. Twenty-seven of 29 infants with chronic kidney disease received peritoneal dialysis, starting at a mean age of 112 d; two children received preemptive renal transplantation (RTx). During follow-up, 21 of 29 children survived with RTx. The 5-yr patient and graft survival rate after RTx was 95.5%. Six of 29 children died, one with a functioning graft and five while on peritoneal dialysis. The main causes of death were severe cardiovascular and cerebral comorbidities. The mean GFR at last follow-up of patients who underwent RTx (mean time after RTx 5.1 yr) was 63.2 ml/min per 1.73 m(2). RRT in infants who are younger than 1 year offers excellent chances of survival and should be offered to all infants who do not have severe, life-limiting extrarenal comorbidity. Contrary to previous observations, the long-term outcome of infants may be comparable to that of older children who undergo RRT.
    Preview · Article · Nov 2009 · Clinical Journal of the American Society of Nephrology
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Achieving normal height in children after renal transplantation is a crucial issue for both quality of life and self-esteem. The management of growth retardation in renal transplant recipients includes adequate nutritional intake, correction of acidosis, optimal drug compliance, limited calcineurin inhibitor nephrotoxicity, steroid-sparing strategies, and sometimes recombinant human growth hormone.
    Full-text · Article · Dec 2009 · Transplantation
Show more