The Growth Hormone Levels and the Effect of Growth Hormone in the Children with Chronic Renal Failure / 대한소아내분비학회지

ABSTRACT

PURPOSE:Growth retardation is a serious clinical problem in children with chronic renal failure(CRF). Dialysis and renal transplantation do not provide an improvement in growth velocity. Possible causes of growth retardation are nutritional deficiency, electrolyte imbalance, uremia, renal asteodystrophy and chronic anemia. However, catch-up growth cannot be achieved after correcting these factors. There is no concordance about disturbances of growth hormone(GH)-insulin-like growth factor-I (IGF-I) axis. in CRF. This study was designed to evaluate the growth status, IGF-I, GH and the effect of GH in CRF. METHODS:Twelve children with CRF(five were treated conservative, seven were transplanted) were included. IGF-I, stimulated GH, 24 hour integrated concentration of GH (IC-GH)were measured. Six were given rhGH(0.1U/kg/day) for average one year. RESULTS: 1)Growth velocity(GV) was 3.2+/-0.8cm/yr(conservative therapy:3.3+/-0.7, transplanted:2.9+/-0.8). Height standard deveation score(SDS) was -2.4+/-1.3cm/yr(conservative therapy group:-3.3+/-1.4, transplanted group:-1.3+/-0.4). Bone age lagged 2.1+/-13yr behind chronological age. 2) IGF-I concentrations were normal. 3)Stimulated GH levels were normal(16.6+/-3.3ng/ml) except one patient. Twenty- four hour IC-GH were less than 3.2ng/ml in 4 patients. 4)After GH therapy, GV increased 3.3+/-0.7cm/yr to 5.4+/-0.8cm/yr and Ht SDS increased -3.3+/-1.4 to -2.9+/-1.5 in the conservatively treated group. GV increased 2.9+/-0.8cm/yr to 5.5+/-1.8cm/yr and Ht SDS increased -1.3+/-0.4 to -0.8+/-0.5 in the transplanted group. CONCLUSION: Stimulated GH was normal but spontaneous secretion of GH was decreased in some patients with CRF. This neurosecretory dysfunction may be one causative factor in CRF. For these patients GH replacement therapy will be effective in promoting growth.