How safe is the treatment of uraemic children with recombinant human growth hormone?

Abstract

Exogenous growth hormone (GH) treatment for growth failure in uraemic children is effective over a period of up to 3 years. The safety of this new treatment modality is remarkably high, at least for this short period of time. Despite a reduced renal metabolic clearance rate of GH in uraemia, exogenous GH does not accumulate in the serum. In a dose range of 28 units/m2 per week, GH does not impair glucose tolerance but increases serum insulin levels, indicating that euglycaemia is maintained at the expense of increased insulin secretion. No alterations of lipid metabolism, mineral metabolism, pituitary-thyroid axis and blood pressure were observed. The GH-induced glomerular hyperfiltration in healthy subjects seems to be obliterated in chronic renal failure. Accordingly, no accelerated progression of renal disease was observed under GH treatment. However, potential side effects during long-term treatment, especially regarding carbohydrate metabolism and malignancy in children under immunosuppression, are not yet excluded.

Glucose Tolerance and Insulin Secretion in Children before and during Recombinant Growth Hormone Treatment

“…Also, HbA1c remained statistically unchanged during rh GH therapy. This is in accordance to data obtained from OGTT [4, 14]. There was an increase of insulin AUC (both early and second phase) in patients with CRF after 6 and 12 months which later returned to baseline values.…”

“…Most findings were based on oral glucose tolerance tests [7, 14]. There is controversy about intravenous glucose tolerance tests [15], and there is a striking difference between up to 50% pathological oral glucose tolerance tests in children with renal insufficiency and the fact that (apart from children with infantile cystinosis) hardly any of these children develop overt diabetes mellitus.…”

“…It has long been established that glucose metabolism and insulin secretion are altered in children with UTS, CRF and after renal transplantation due to various mechanisms [1, 2, 12, 13, 14, 15]. Most findings were based on oral glucose tolerance tests [7, 14].…”

Differential Effects of Growth Hormone and Alfa Calcidol on Trabecular and Cortical Bones in Hypophysectomized Rats

“…Conversely, GH increases metaphyseal trabecular and endocortical bone formation without enhancing resorption, as measured by the osteoclast cell number per bone area and erosion surface indicating that growth hormone increases net bone formation at both sites that predominantly undergo coupled formation and resorption in the skeleton in the HX rats. Consequently, the use of agents with antiresorptive properties in combination with anabolic agent like GH should be helpful in enhancing the net bone formation, and antiresorptive agent would be helpful in suppressing bone resorption, although improving the net bone gain (33)(34)(35)(36)(37). Results of bone density, trabecular and cortical bone mass, and the dynamic histomorphometry of the current study demonstrate that the combined intervention of GH and 1OHD has a benefit of increasing bone growth, elongation, and also preventing bone loss better than the treatment with either agent alone in the animals with pituitary hormone deficiency.…”

Subclinical activation of lupus nephritis by recombinant human growth hormone

“…In children with pre-terminal chronic renal failure, supraphysiological doses of GH have been shown to accelerate the growth velocity, without any significant side effects, such as exacerbation of the glucose intolerance of uremia [2]. However, GH receptors are found on lymphocytes and monocytes, and this raises the possibility that GH may affect the immune system directly [3,4].…”