Growth Retardation in Childhood Renal Disease: A Hormonal or Nutritional Problem?

Chesney, Russell W.

doi:10.1159/000167481

Cited by 10 publications

(3 citation statements)

References 13 publications

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“…Similar findings have been noted in other animal models of chronic renal insufficiency (3)(4)(5). Disturbances in the growth hormone/somatomedin system have been implicated in the etiology of the reduced growth rates of children with renal insuffi-ciency (6,7 ) ; however, the mechanisms remain unclear. The recent availability of large quantities of recombinant human growth hormone (8) may open new avenues for the treatment of growth retardation in uremic children.…”

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confidence: 78%

The Effects of Exogenous Rat Growth Hormone Therapy on Growth of Uremic Rats Fed an 8% Protein Diet

et al. 1989

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ABSTRACT. Although the mechanisms underlying the inhibitory effects of chronic renal insufficiency on growth are poorly understood, large doses of growth hormone (GH) have been used to improve growth. The present study examines the effects of rat G H and a reduced (8%) protein diet on 75% nephrectomized weanling rats by measuring changes in growth parameters, food utilization, serum albumin concentration, and muscle water content. Significantly greater improvement in growth was found in the GH-treated uremic rats compared with the uremic controls. The mean percent change in wt, length (nose to tail tip), and cranial biparietal diameter was significantly increased in the GH-treated uremic rats, compared with the uremic controls, but foot length and femur length showed only moderate improvement. Food utilization efficiency and serum albumin concentration were significantly higher in GH-treated uremic rats compared with uremic controls, achieving levels that were not different from sham-operated rats. Muscle water content was not significantly different between GH-treated uremic rats, uremic controls, and sham-operated rats. Thus, rat G H treatment administered a t an early age in mild renal insufficiency significantly improved overall growth, food efficiency, and serum albumin concentrations, despite a low protein diet, suggesting that further evaluation of this form of therapy for growth failure of uremia is warranted. (Pediatr Res 26:204-207, 1989) Abbreviations GH, growth hormone U, uremic control group U + GH, uremic rats treated with growth hormone Growth failure is a major complication of chronic renal insufficiency in children. Adult stature is usually far below that expected for a child's genetic potential, even with adequate dialysis, treatment of acidosis, administration of phosphate binders, nutritional counseling, and supplemental vitamin D ( 1 , 2). Similar findings have been noted in other animal models of chronic renal insufficiency (3)(4)(5). Disturbances in the growth hormone/somatomedin system have been implicated in the etiology of the reduced growth rates of children with renal insuffi- Received February 6, 1989; accepted May 8, 1989. Correspondence Dr. James C. M. Chan, Medical College of Virginia, 1101 E. Marshall St., Richmond, VA 23219.ciency (6, 7 ) ; however, the mechanisms remain unclear. The recent availability of large quantities of recombinant human growth hormone (8) may open new avenues for the treatment of growth retardation in uremic children. Preliminary data suggest that large doses of recombinant growth hormone can improve growth in uremic children (9).Large doses of heterologous growth hormone have been used to overcome the inhibitory effect of uremia on growth in fivesixths nephrectomized rats fed 22-24% protein diets (10, 1 1 ) . With respect to the current concerns regarding the role of high protein intake in the progression of renal damage, the present study was designed to examine the effects of parenteral rat G H in rapidly growing weanling rats with mild chronic ren...

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supporting

confidence: 78%

The Effects of Exogenous Rat Growth Hormone Therapy on Growth of Uremic Rats Fed an 8% Protein Diet

et al. 1989

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“…(Pediatr Res 31: 528-531,1992) Abbreviations CRI, chronic renal insufficiency GH, growth hormone GHRH, growth hormone-releasing hormone CRI in children is frequently complicated by growth failure (1 -5). The etiology of this growth failure is complex, and nutritional, metabolic, and hormonal disturbances have been implicated (3,(5)(6)(7).…”

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Growth Hormone Secretory Capacity of Individual Somatotropes in Rats with Chronic Renal Insufficiency

et al. 1992

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ABSTRACT. Growth failure is a common consequence of chronic renal insufficiency (CRI) in children and may be due to a number of factors. With regard to growth hormone (GH), regulation is often abnormal in CRI patients. The present study investigated the effect of CRI on the GH secretory responsiveness to GH-releasing hormone in individual rat pituitary somatotropes. Male Sprague-Dawley rats underwent a 5/6 nephrectomy to produce CRI. Control rats (SHAM) received sham operations, which included kidney decapsulation but not removal. Two wk later, during a period of stable uremia, serum creatinine [CRI: 1.1 f 0.08 mg/dL (97 f 7 pmol/L); SHAM: 0.4 f 0.04 mg/dL (35 f 4 pmol/L)] and serum urea nitrogen [CRI: 60.7 f 8.3 mg/dL (21.7 2 3.0 mmol/L); SHAM: 15.8 f 1.2 mg/ dL (5.6 f 0.4 mmol/L)] were significantly elevated in the CRI rats (p < 0.0005). Weight gain (p < 0.0005), length gain ( p < 0.0005), food intake (p < 0.0005), and food efficiency ( p < 0.005) were all significantly lower in the CRI rats. The G H secretory capacity of individual somatotropes was determined using the reverse hemolytic plaque assay technique. Plaque areas were measured to assess relative amounts of GH secreted. The total number of pituitary cells per rat, the percentage of somatotropes, and the mean plaque areas were similar for the two groups. These findings compare favorably with our in vitro study of GH responsiveness in perifused rat pituitary cells under conditions of mild uremia. We conclude that the secretory responsiveness of individual somatotropes is not significantly changed under conditions of moderate CRI, and that potential abnormalities in GH secretion are due to factors other than an alteration in the capability of somatotropes to respond to GH-releasing hormone. (Pediatr Res 31: 528-531,1992) Abbreviations CRI, chronic renal insufficiency GH, growth hormone GHRH, growth hormone-releasing hormone CRI in children is frequently complicated by growth failure (1 -5). The etiology of this growth failure is complex, and nutritional, metabolic, and hormonal disturbances have been implicated (3, 5-7).

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“…Τα στοιχεία αυτά δείχνουν ότι παρόλο που η ελαττωμένη πρόσληυ,η θερμίδων καί πρωτεϊνών συσχετίζεται με το χαμηλό ανάστημα, δεν αποτελεί καθοριστικό παράγοντα για την καθυστερημένη απαραίτητη γιά την ανάπτυξη, όμως η αύξηση των θερμίδων πέρα από 80% περίπου της RDA δεν συνοδεύεται από επιτάχυνση της αύξησης σε παιδιά με πλημμελή ανάπτυξη.Ιδιαίτερα σημαντική είναι η επαρκής θερμιδική πρόσληιιη στα δύο πρώτα χρόνια της ζωής, όπου το χαμηλό ανάστημα μπορεί να βελτιωθεί ή και να προληφθεί με σωστή και έγκαιρη αντιμετώπιση.2.3. Οξέωση και διαταραχές ύδατος και ηλεκτρολυτώνΗ οξέωση και οι διαταραχές ύδατος και ηλεκτρολυτών αναφέρονται σαν παράγοντες που συμβάλλουν στην καθυστερημένη αύξηση των παιδιών με ΧΝΑ(19). Η μεταβολική οξέωση παρουσιάζεται στα περισσότερα παιδιά όταν η GFR (glomerular filtration rate, σπειραματική διήθηση) μειωθεί περισσότερο από 50% και οφείλεται κυρίως στην μειωμένη ικανότητα του νεφρού να αποβάλλει αμμωνία.…”

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Χορήγηση Βιοσυνθετικής Αυξητικής Ορμόνης Σε Παιδιά Με Χρόνια Νεφρική Ανεπάρκεια Τελικού Σταδίου Που Βρίσκονται Σε Υποκατάσταση.

Kousta¹,

Κούστα²

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2.1. Πρωτοπαθής νεφρική υόσος 8 2.2. Διαταραχές στη öpsyn 8 2.3. Οξέωση και διαταραχές ύδατος και ηλεκτρολυτών 10 2.4. Αναιμία 11 2.5. Νεφρική οστεοδυστροφία 12 2.6. Ορμονικές διαταραχές 15 2.6.1. Διαταραχές γλυκόζης και ινσουλίνης 15 2.6.2. Διαταραχές στον άξονα υποθάλαμος-υπόφυση-γονάδες 18 2.6.3. Διαταραχές στον άξονα αυξητική ορμόνη-σωματομεδίνες 19 3. ΑΥΞΗΤΙΚΗ ΟΡΜΟΝΗ-ΣΩΜΑΤΟΜΕΔΙΝΕΣ 20 3.1. Αυξητική ορμόνη 20 3.2. Σωματομεδίνες 25 3.3. Αντίσταση στη δράση της GH στην ουραιμία 29 4. ΑΞΙΟΛΟΓΗΣΗ ΤΗΣ ΑΥΞΗΣΗΣ ΠΑΙΔΙΩΝ ΜΕ ΧΝΑ 30 4.1. Ανθρωπομετρικοί προσδιορισμοί 30 4.2. Στατιστική ανάλυση της αύξησης 31 5. ΧΟΡΗΓΗΣΗ ΑΥΞΗΤΙΚΗΣ ΟΡΜΟΝΗΣ ΣΤΗΝ ΧΝΑ 33 5.1. Πόσο ασφαλής είναι η χρήση της αυξητικής ορμόνης. Εμπειρία από τη χορήγηση της σε άλλες παθολογικές καταστάσεις 33 5.2. Χορήγηση αυξητικής ορμόνης στην ουραιμία 34 5.3. Συμπεράσματα 37

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Growth Retardation in Childhood Renal Disease: A Hormonal or Nutritional Problem?

Cited by 10 publications

References 13 publications

The Effects of Exogenous Rat Growth Hormone Therapy on Growth of Uremic Rats Fed an 8% Protein Diet

The Effects of Exogenous Rat Growth Hormone Therapy on Growth of Uremic Rats Fed an 8% Protein Diet

Growth Hormone Secretory Capacity of Individual Somatotropes in Rats with Chronic Renal Insufficiency

Χορήγηση Βιοσυνθετικής Αυξητικής Ορμόνης Σε Παιδιά Με Χρόνια Νεφρική Ανεπάρκεια Τελικού Σταδίου Που Βρίσκονται Σε Υποκατάσταση.

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