CHANGES IN BONE-MINERAL DENSITY, GROWTH VELOCITY AND RENAL-FUNCTION OF PREPUBERAL UREMIC CHILDREN DURING GROWTH-HORMONE TREATMENT

Thirteen prepubertal children with a mean chronological age of 6.7 +/- 3.4 years and severe chronic renal failure (mean glomerular filtratio n rate of 20.8 +/- 17.7 ml/min/1.73 m(2)) were studied. Patients recei ved recombinant human growth hormone (rhGH) at a dose of 1 IU/kg/week given subcutaneously on a daily basis for 12 months. Mean growth rates of our patients increased significantly from a baseline level of 4.3 +/- 2.1 to 9.1 +/- 2.0 cm/year at 12 months of rhGH therapy, Mean heig ht SDS improved from -3.5 +/- 1.0 at initiation of therapy to -2.6 +/- 1.3 at 12 months. Mean serum creatinine and blood urea nitrogen level s remained stable during the study, while mean glomerular filtration r ates decreased initially and then stabilized; however, 2 subjects had a significant deterioration of their renal function at 6 and 9 months of rhGH, requiring discontinuing treatment, Before rhGH treatment, tot al bone mineral content as well as bone mineral density in cortical an d trabecular bone were significantly reduced in our patients when comp ared to healthy controls paired for chronological age and similar to t hose of a healthy control group paired for bone age and height, Both t hese parameters increased significantly during rhGH treatment so that at 12 months our patients had values similar to those seen in a health y control population paired to our patients for chronological age. Whi le trabecular bone mineral density did not change in a group of untrea ted uremic controls during 12 months of follow-up, the percent of bone mineral density change in trabecular bone in our uremic patients duri ng 12 months of rhGH treatment was very significant (p < 0.001) and la rger than that noted in a group of healthy controls paired for bone ag e and height during 12 months of follow-up. This study demonstrates ho w rhGH treatment in prepubertal uremic children increases their growth velocity and their bone mineral density significantly, with an improv ement in height for age. Careful followup of the renal function of pat ients in needed as they improve their height and bone mineral status.