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Growth hormone treatment in children with preterminal chronic renal failure: No adverse effect on glomerular filtration rate

  • Nephrology
  • Published:
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Abstract

Impaired growth and stunting remains a major therapeutic problem in children with chronic renal failure (CRF). Recombinant human growth hormone (rhGH) treatment may be beneficial, but concern has been raised about possible side-effects, i.e. deterioration of renal function and glucose intolerance. We have treated 10 prepubertal children with CRF (median age 7.5 [1.7–10.0] years) with 4 IU rhGH/m2 per day s.c. over a period of 1 year. Height velocity increased significantly (P<0.03) from basal 4.6 (2.0–14.0) cm/year to 9.7 (6.8–17.6) cm/year. Height velocity SDS for chronological age and for bone age increased in all children from basal median −2.3 to +3.8 (P<0.005). Median glomerular filtration rate (GFR) measured by single injection inulin clearance at onset was 18 (11–66) ml/min per 1.73 m2 and did not change significantly during the treatment year. The loss of GFR as estimated by creatinine clearance was similar during the treatment year (median loss 1.3 ml/min per 1.73 m2) compared to the year before treatment (median loss 3.7 ml/min per 1.73 m2). Serum glucose levels during an oral glucose tolerance test did not change, but fasting as well as stimulated insulin levels increased significantly with time during the study period. It is concluded that the rhGH regimen employed was remarkably effective in improving growth velocity in children with CRF without adversely affecting GFR. Glucose homeostasis remained stable, but at the expense of increased serum insulin levels.

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Abbreviations

BA:

bone age

CA:

chronological age

CRF:

chronic renal failure

GRF:

glomerular filtration rate

GH:

growth hormone

IGF:

insulin-like growth factor

IGF-BP:

insulin-like growth factor binding protein

MAC:

mid-arm circumference

MAMC:

mid-arm muscle circumference

OGTT:

oral glucose tolerance test

rhGH:

recombinant human growth hormone

SDS:

standard deviation score

TSF:

triceps skin fold

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Authors and Affiliations

  1. Division of Paediatric Nephrology and Department of Paediatric Endocrinology, University Children's Hospital, Im Neuenheimer Feld 150, W-6900, Heidelberg, Germany

    B. Tönshoff, O. Mehls, J. Pinkowski & U. Heinrich

  2. Department of Paediatric Nephrology, University Children's Hospital, Hufelandstrasse 55, W-4300, Essen, Germany

    C. Tönshoff

  3. Department of Paediatric Endocrinology, University Children's Hospital, Rümelinstrasse 23, W-7400, Tübingen, Germany

    W. F. Blum

  4. Department of Radiology, University Hospital, Hugstetterstrasse 55, W-7800, Freiburg, Germany

    B. Stöver

  5. Clinic of Nephrology, Klinikum Mannheim, Theodor-Kutzer-Ufer, W-6800, Mannheim, Germany

    N. Gretz

Authors
  1. B. Tönshoff
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  2. C. Tönshoff
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  4. J. Pinkowski
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  5. W. F. Blum
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  6. U. Heinrich
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  7. B. Stöver
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  8. N. Gretz
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Tönshoff, B., Tönshoff, C., Mehls, O. et al. Growth hormone treatment in children with preterminal chronic renal failure: No adverse effect on glomerular filtration rate. Eur J Pediatr 151, 601–607 (1992). https://doi.org/10.1007/BF01957731

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  • DOI: https://doi.org/10.1007/BF01957731

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