Long-term experience with growth hormone treatment in children with chronic renal failure

After a decade of experience with recombinant human growth hormone (rhGH) i n children with chronic renal failure (CRF), the long-term efficacy and saf ety of the drug is now established. In prepubertal children, partial catch- up growth is achieved during the first three treatment years, followed by s ustained percentile-parallel growth. Discontinuation of rhGH treatment resu lts in catch-down growth in 75% of patients. Treatment efficacy is inversel y correlated with age and baseline height velocity, and positively influenc ed by genetic target height and residual renal function. Skeletal maturatio n is not accelerated, suggesting a true increase in final height potential. Side effects are limited to a stimulation of insulin secretion, which is n ot associated with changes in glucose tolerance, and occasional cases of be nign intracranial hypertension. In summary, the advent of rhGH has opened a new era in the management of gr owth failure in CRF. Available evidence suggests that treatment should star t in early childhood and early in the course of renal failure, and should b e continued at least until renal transplantation. It remains to be seen whe ther the beneficial effect of rhGH on height observed during the prepuberta l period will result in an eventual increase in adult height.