Therapeutic value of recombinant human growth hormone in children with chronic renal failure.

In chronic renal failure (CRF), serum growth hormone (GH) levels are elevated due to a reduced renal metabolic clearance. Although the concentration of circulating GH is increased in CRF, insensitivity to GH is noted. This is mainly due to a decreased production of hepatic insulin-like growth factor (IGF)-I and an accumulation of its binding protein (IGFBP-3), both resulting in a low concentration of free active IGF-I. Treatment with recombinant human (rh) GH in doses of about 30 IU/m2/week, increases the serum concentration of IGF-I, normalizes somatomedin (IGF) bioactivity and leads to catch-up growth. The anabolic effects of rhGH are seen from an increase in muscle mass and a reduction of fat mass. rhGH treatment is also able to compensate for the growth-depressing effects of corticosteroids in animal studies and in children after renal transplantation.