Indications for recombinant growth hormone (rhGH) treatment in kidney diseases]

Growth retardation is one of the major problem in children with chronic and terminal renal failure. The growth hormone-insulin-like growth factor axis is altered in uraemia, resulting in peripheral resistance. This insensitivity seems to be overcome in an experimental study by supraphysiological doses of recombinant human growth hormone (rhGH). Several clinical studies have confirmed that rhGH increases growth velocity in children with chronic renal failure with and without dialysis and after renal transplant, without significant side-effects. The improvement of growth is more marked in prepubertal patients and during the first year of rhGH treatment. Also in our experience prepubertal children showed an increase of height standard deviation score and growth velocity during rhGH treatment; the pubertal patients failed to improve their statural growth. GH, as the prototype of an anabolic hormone, has also great potential in improving catabolic conditions of various origin, particularly those due to renal failure. RhGH can improve nitrogen balance and the nutritional parameters with an increase of muscle mass and a decrease of fat mass. Prospectively, rhGH could be utilized to improve the hypercatabolic condition of acute renal failure. The following analysis will discuss the recent studies employing rhGH in renal diseases and will attempt to give some guide lines to rhGH treatment in these illnesses.