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Growth hormone therapy in children with CKD after more than two decades of practice

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Abstract

This review focuses on the evidence for the efficacy and safety of recombinant human growth hormone (rhGH) therapy in children with all stages of chronic kidney disease (CKD) and at all ages. It describes the improving height prognosis for our patients both with and without rhGH; explains the underlying hormonal abnormalities that provide the rationale for rhGH use in CKD and the endocrine changes that accompany treatment; and views on who warrants treatment, with what dose, and how long for.

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Authors and Affiliations

  1. Gt Ormond St Hospital for Children NHS Foundation Trust, London, WC1N3JH, UK

    Lesley Rees

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  1. Lesley Rees
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Answers

1. e

2. c

3. d

4. e

5. c

Multiple-choice questions (answers are provided following the reference list)

Multiple-choice questions (answers are provided following the reference list)

  1. 1.

    Which is NOT true? Improved final height in children who are on RRT is associated with:

    1. a.

      Older age at start of RRT

    2. b.

      A more recent era for the start of RRT

    3. c.

      Cumulative percentage time with a transplant

    4. d.

      Greater HtSDS at initiation of RRT

    5. e.

      Longer duration of dialysis

  2. 2.

    Which of the following does not occur in CKD?

    1. a.

      GH levels may be increased

    2. b.

      GH secretion is reduced by metabolic acidosis, malnutrition, and steroids

    3. c.

      Growth hormone binding protein levels are high

    4. d.

      SOCS dephosphorylate the GH-activated JAK-STAT cascade and so exert a GH-regulated negative feedback loop

    5. e.

      GH increases the ratio of IGF-1 to IGFBP3

  3. 3.

    Which of the following factors at the start of treatment is not associated with a good response to rhGH?

    1. a.

      Younger age

    2. b.

      Lower HtSDS

    3. c.

      Greater target-height deficit

    4. d.

      Better growth velocity

    5. e.

      Greater bone age retardation

  4. 4.

    Which is true? rhGH is associated with:

    1. a.

      Acceleration of bone age compared to chronological age

    2. b.

      Increased rate of progression of CKD

    3. c.

      Rejection episodes in transplant patients

    4. d.

      No improvement in body composition

    5. e.

      Benign intracranial hypertension

  5. 5.

    Which is NOT true? RhGH:

    1. a.

      Has been shown to be effective in RCTs over 2 years of treatment

    2. b.

      It is unlikely that this height gain will be lost and is therefore expected to contribute to an improvement in final height.

    3. c.

      There are RCTs of its effect on final height

    4. d.

      The final height of children on RRT is improving

    5. e.

      The contribution of rhGH to the improvement in final height is unknown

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Rees, L. Growth hormone therapy in children with CKD after more than two decades of practice. Pediatr Nephrol 31, 1421–1435 (2016). https://doi.org/10.1007/s00467-015-3179-2

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  • DOI: https://doi.org/10.1007/s00467-015-3179-2

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