25 TREATMENT OF CHRONIC RENAL FAILURE WITH GROWTH-HORMONE-RELEASING HORMONE

Abstract

Growth retardation is common in children with chronic renal failure (CRF) and after renal transplantation (Tx). For this reason we treated 9 children (3 on conservative treatment, CT; 3 on dialysis, D; and 3 Tx), aged 1.6 to 14.0 (x±sd; 8.1 ± 4.3) years, with twice daily subcutaneous injections of growth - hormone-releasing analogue, GHRH (1-29)NH2 Serono at a mean dose of 26±7 ug/kg/day, during 2 to 6 months. Mean serum urea and creatinine remained stable, although in CT patients serum creatinine increased moderately. Before treatment, mean bone age was 5.2 ± 3.1 years, height SDS -2.2±0.6 and growth velocity 4.5±2.9 cm/year (-2.3±2.0 DS for chronological age). Mean nocturnal spontaneous growth hormone (xGH) was 3.3±1.6 ng/ml, smooth line 1.6±0.9 ng/ml, amplitude 5.4±2.6 ng/ml, number of peaks 3.8±1.3 and growth hormone (GH) response to GHRH test (1 ug/kg IV) 61.7±52.5 ng/ml. Five patients, all 3 on CT included, increased the height velocity from 3.8±1.6 to 8.0±2.6 cm/year. The peak GH response to GHRH was significantly higher in the group of growth non-responders than the responders (p<0.05). Conclusion: GHRH treatment increased growth velocity in 55% of our patients. All CT patients had a worthwhile response to therapy: height velocity increased by more than 2 cm/year. Growth response to GHRH was lower when GH response to GHRH test was high, suggesting peripheral resistance to the biological action of GH.