EFFICACY AND SAFETY OF ONE-YEAR OF GROWTH-HORMONE THERAPY IN STEROID-DEPENDENT NEPHROTIC SYNDROME

Objectives: To study the efficacy and safety of 1 year of growth hormo ne (GH) therapy in children with steroid-dependent nephrotic syndrome. Study design: A prospective pilot, open study in which GH (mean dose 0.32 mg/kg per week) was administered for 1 year to 8 children with st eroid-dependent nephrotic syndrome requiring prednisolone (mean dose 0 .46 mg/kg per day) to maintain remission. Steroid dependence was defin ed as recurrence of proteinuria within 2 weeks of discontinuation of p rednisolone, or when the dose was lowered below a critical level. At e ntry, all patients had been steroid dependent far at least 1 year. Ant hropometric and bone mineral density measurements after treatment were compared with 1-year pretreatment data. Results: Pretreatment mean (/-SD) chronologic age was 12.6 (+/-3.1) years, with a mean bone age of 9.1 (+/-2.0) years, with delayed puberty in five patients, The mean h eight velocity increased from 3.7 (+/-1.4) to 9.4 (+/-2.1) cm/yr after 1 year of treatment (p < 0.05). The mean height standard deviation sc ore increased from -1.4 (+/-1.6) to -0.3 (+/-1.1), (p < 0.05). In the spine, the mean bone mineral density increased from 0.50 to 0.64 gm/cm (2) (p < 0.05), and in the femoral neck, from 0.55 to 0.64 gm/cm(2) (p < 0.05) after 1 year of treatment. Mean lean body mass increased from 58.1% to 62.6% (p < 0.01). There were tao significant changes in crea tinine clearance, fasting glucose, fasting insulin, or glycosylated he moglobin levels. The mean bone age increased to 11.4 (+/-2.4) years, a nd pubertal stage advanced in 2 patients. Conclusion: One year of GH t herapy is effective in improving the height standard deviation score, height velocity, bone mineral density, and lean body mass of children with steroid-dependent nephrotic syndrome. There were no significant a dverse effects. However, the bone age accelerated at a greater pace th an the height age, and further studies are required to define the role of GH therapy in steroid-dependent nephrotic syndrome.