GROWTH-HORMONE TREATMENT BEFORE AND AFTER RENAL-TRANSPLANTATION

Children with chronic renal disease may improve height with growth hor mone (GH) treatment. We studied 2 groups of children with height below 1.8 SDS and/or height velocity (HV) below, the 3rd centile: 1) 6 pati ents with end stage renal disease (ESRD) on dialysis, aged 12.2 +/- 4. 4 years (x +/- sd), with bone age of 6.8 +/- 3.3 years, 3 with Tanner stage I and 3 Tanner II; and 2) 6 children with functioning renal tran splants, aged 15.5 +/- 2.5 years, with bone age 10.0 +/- 2.3 years, Ta nner II-IV. Maintenance dosage of orally administered methylprednisone (MP) was 0.16 +/- 0.04 mg/kg/day. 1) Children with ESRD received GH d uring 1 to 3.5 years. Height SDS and HV (x +/- sd) were: pre GH -3.8 /- 0.6 SDS and 2.6 +/- 1.4 cm/y; at 1 year of GH therapy (n = 6) - 3.9 +/- 0.4 SDS and 5.1 +/- 3.2 cm/y; at 2 years (n =5) -4.2 +/- 0.5 SDS and 3.1 +/- 0.7 cm/y; at 3 years (n = 4) -4.1 +/- 0.7 SDS and 3.3 +/- 1.5 cm/y. Height SDS and Hv did not change significantly. 2) Transplan ted patients received GH during 1 to 2 years. Height SDS and HV were: pre GH -3.0 +/- 1.9 SDS and 3 +/- 1 cm/y; at 1 year -2.5 +/- 1.5 SDS ( p < 0.05) (t paired test) and 6.9 +/- 2.3 cm/y (p < 0.01). Height SDS and HV increased; creatinine clearance remained stable; there was corr elation between height SDS and serum creatinine r = -0.81, creatinine clearance and HV r = 0.92, MP dose and HV r =-0.85. Five of 6 patients reached adult height of -2.8 +/- 1.3 SDS, below their target height o f -0.3 +/- 0.7 SDS (p < 0.005). Conclusion: In patients with ESRD, GH therapy did not improve significantly height SDS and HV. In pubertal t ransplanted patients height SDS and HV improved and renal function rem ained stable; final height remained below expected genetic height. Pro longed periods of GH therapy are necessary to evaluate ii final height can be improved with GH.