Growth hormone treatment in children with chronic kidney disease and postrenal transplantation
- Burkhard Tönshoff, MD, PhD
Burkhard Tönshoff, MD, PhD
- Professor of Pediatrics and Pediatric Nephrology
- University Children's Hospital, Heidelberg, Germany
Growth impairment is a common problem in children with chronic kidney disease (CKD) and is associated with significant morbidity and mortality [1,2]. Several factors may contribute, including inadequate nutrition, metabolic acidosis, renal osteodystrophy, and insensitivity to the action of growth hormone (GH) [3-7].
Management to prevent and correct growth impairment due to CKD includes supportive measures that correct amenable complications of CKD (eg, poor nutrition and metabolic acidosis) and renal replacement therapy (RRT), particularly renal transplantation. However, despite these interventions, poor growth persists in a significant proportion of children with CKD, including renal allograft recipients. In children who have persistent growth impairment, recombinant human growth hormone therapy (rhGH) is an effective and well-tolerated intervention that improves growth.
The use of rhGH in children with CKD, including efficacy, indications, and dosing will be reviewed here. The pathogenesis, risk factors, evaluation, and overall management of growth impairment in children with CKD are discussed separately. (See "Pathogenesis, evaluation and diagnosis of growth impairment in children with chronic kidney disease" and "Prevention and management of growth failure in children with chronic kidney disease".)
Z-height score — The growth measurement Z-score for height is a conversion of height/length that represents the number of standard deviations (SD) from the mean height for age. A child with a height Z-score <-1.88 has short stature. (See "Measurement of growth in children", section on 'Z-scores'.)
Growth or height velocity — Growth or height velocity, the change in growth over time, is a more sensitive index of growth than is a single measurement. Current height/length measures are compared with previous growth points to determine the interval growth/height velocity (figure 1 and figure 2).
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- Z-height score
- Growth or height velocity
- MECHANISM OF ACTION
- Clinical trials
- NAPTRCS observational data
- Specific populations
- - Prepubertal patients
- CKD without RRT
- Renal transplantation
- - Infants
- - Pubertal children
- Final adult height
- INITIATION OF rhGH THERAPY
- Timing and indications
- - Predictors for growth response to rhGH
- - Indications
- Dose of rhGH
- - Frequency and mode of administration
- MONITORING RESPONSE AND FOR ADVERSE EFFECTS
- Response to rhGH
- Adverse effects
- Failure of response
- Duration of therapy
- SUMMARY AND RECOMMENDATIONS