ABSTRACT
Statural growth in children with chronic renal failure (CRF) is often delayed. Several studies have shown that one of the main causes is partial resistance to growth hormone (GH), which can be overcome by supraphysiologic doses of recombinant human (rh) GH. Since August 1990 we have been treating 8 boys and 1 girl (ages 1.7-12.7, mean 5.3 yrs) with rhGH (4 IU/m2 s.c. daily). All patients were prepubertal and were 2.4-4.5 (mean 3.2) SDS below the mean normal height for age and sex. 5 patients were on dialysis. Mean growth velocity was -2.0 SDS (5.4 cm/yr) before and +2.6 SDS (9.5 cm/yr) during the first year of therapy with rhGH. Mean height increased from -3.2 to -2.5 SDS at 1 year. Height in the 4 boys treated > 2 yrs with rhGH improved from -3.3 SDS (before rhGH) to -2.4 (1st yr) and to -2.0 SDS (2nd yr); their height increased by 9.6 cm (1st yr) and 7.8 cm (2nd yr) as compared to 4.6 cm in the year before treatment. The response to rhGH was better in the 4 patients treated conservatively than in those on dialysis. Side effects did not occur. Plasma insulin increased but the oral glucose tolerance test remained normal. We conclude that treatment with rhGH represents an important step forward in selected pediatric patients with CRF. The excellent acceptance reflects the high expectations of the patients and their families.
Subject(s)
Growth Disorders/drug therapy , Growth Hormone/therapeutic use , Kidney Failure, Chronic/complications , Child , Child, Preschool , Female , Growth/drug effects , Growth Disorders/etiology , Growth Hormone-Releasing Hormone/metabolism , Humans , Infant , Kidney Failure, Chronic/therapy , Male , Recombinant Proteins/therapeutic use , Renal DialysisABSTRACT
Eighteen patients aged 5-18 years on regular dialysis had a packed cell volume (PCV) less than 0.27. On treatment with epoetin alfa (EA) PCV increased by 0.05 or more in all patients. Iron supplementation was necessary in 13 patients with a ferritinaemia less than 300 micrograms/l before study. During treatment, plasma potassium increased significantly and more vigorous antihypertensive measures were required in 8 patients, 5 of them being already on antihypertensive drugs before EA. Iliofemoral thrombosis occurred in 1 patient 10 days after renal transplant. The data indicate that EA ameliorates the anaemia of chronic renal disease. The main concerns arising during treatment with EA are hyperkalaemia, arterial hypertension and possibly thrombosis.
Subject(s)
Anemia/drug therapy , Erythropoietin/therapeutic use , Renal Dialysis/adverse effects , Adolescent , Anemia/etiology , Child , Child, Preschool , Erythropoietin/adverse effects , Erythropoietin/pharmacology , Female , Hematocrit , Humans , Hypertension/chemically induced , Kidney Failure, Chronic/complications , Male , Recombinant Proteins/adverse effects , Recombinant Proteins/pharmacology , Recombinant Proteins/therapeutic useABSTRACT
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