Growth hormone treatment after renal transplantation: a promising but underused chance to improve growth

Abstract

Growth retardation remains a clinical problem in children with chronic kidney disease (CKD) prior to and during end-stage renal disease. The growth of approximately 40 % of children on dialysis is stunted. Even so, growth hormone treatment (GH) is not used in the majority of small children prior to transplantation. Also, GH is effective in improving growth after transplantation, but again, it is only rarely used in this situation mainly for fear of triggering rejection episodes. In controlled studies, the number of patients who developed rejection episodes with GH was no greater than the number in untreated controls. However, patients with prior frequent rejection episodes developed further repeated subsequent rejection episodes. Many patients with repeated rejection episodes before GH treatment have reduced renal function and are expected to proceed to dialysis or retransplantation. We believe that in these patients, early individual decisions for or against GH treatment should be made as soon as other treatment strategies, such as steroid withdrawal, have failed or are not indicated. Decisions for GH treatment at a later pubertal age come too late for significant growth response and/or improvement of final height.

Cysteine induces longitudinal bone growth in mice by upregulating IGF-I

“…Growth retardation is a major concern in children with chronic inflammatory diseases, uncontrolled juvenile idiopathic arthritis and chronic kidney disease (40)(41)(42). Thus, many children are administered the anti-inflammatory drug, dexamethasone.…”

We have to do more for former paediatric renal transplant recipients!

“…End en et al also confirmed the importance of final height, similar to the findings by Broyer [4]. Despite the proven effectiveness of growth hormone supplementation, poor adherence to this treatment post-transplant has been reported from patient/caregiver and providers [12]. Moreover, even with significant advances in immunosuppression regimes [13], the long-term rehabilitation of these patients still leaves a lot to be desired.…”

Congenital nephrotic syndrome and recurrence of proteinuria after renal transplantation

“…Long-term graft function in infants is similar to that in older children. A recent finding has also shown that growth is good, in fact catch up growth in infants is better [ 25 ], puberty is normal, and final height is acceptable in patients transplanted as infants [ 26 ]. Neurocognitive function in children without co-morbidities or complications before RTx is satisfactory and family coping is excellent in developed societies with social support [ 27 ].…”