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Management of growth retardation in pediatric recipients of renal allografts

Nature Clinical Practice Nephrology volume 3, pages 318–324 (2007)Cite this article

Abstract

Growth retardation frequently accompanies chronic kidney disease in children. Unfortunately, this retardation persists in magnitude despite assiduous therapeutic efforts, adequate dialytic intervention, and successful transplantation. The age of the patient at transplantation, allograft function, and corticosteroid dosage are the major factors that contribute to persistent suboptimal growth following renal transplantation. Recent data indicate that the use of recombinant human growth hormone might efficaciously improve growth velocity in the persistently growth-retarded allograft recipient. Attainment of optimum final adult height is predicated on optimum height at the time of transplantation, persistent optimum allograft function, minimization or avoidance of corticosteroid treatment, and, possibly, use of recombinant human growth hormone, especially to potentially maximize the pubertal growth spurt.

Key Points

  • Retardation of growth is a consequence of pediatric chronic kidney disease that is not universally overcome by dialysis or transplantation

  • Factors that affect post-transplantation growth include age at time of transplantation, allograft function, and use of corticosteroids

  • Randomized controlled trials indicate that recombinant human growth hormone is a well tolerated and effective treatment for post-transplantation growth retardation

  • Approval of recombinant human growth hormone for this indication has not been sought from the US FDA or European regulatory bodies

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Figure 1: In the past two decades, there has been a steady improvement in the height standard deviation scores of pediatric renal allograft recipients at the time of transplantation
Figure 2: Following transplantation, height delta z-scores improve in pediatric renal allograft recipients aged 0–1 year or 2–5 years at the time of transplantation
Figure 3: Post-transplantation treatment with recombinant human growth hormone (Nutropin®; Genentech, South San Francisco, CA) accelerates improvement of delta height
Figure 4: Response of a pediatric kidney transplant recipient to treatment with recombinant human growth hormone

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Acknowledgements

Désirée Lie, University of California, CA, is the author of and is solely responsible for the content of the learning objectives, questions and answers of the Medscape-accredited continuing medical education activity associated with this article.

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  1. Stony Brook University Medical Center, Office of the Dean, HSC Level 4, Suite 170, Stony Brook, NY 11794–8430, USA richard.fine@stonybrook.edu

Authors and Affiliations

  1. RN Fine is Dean of the School of Medicine at Stony Brook University Medical Center, Stony Brook, New York, NY, USA.,

    Richard N Fine

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Fine, R. Management of growth retardation in pediatric recipients of renal allografts. Nat Rev Nephrol 3, 318–324 (2007). https://doi.org/10.1038/ncpneph0502

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