Rangel Gloria A, Ariceta Gema
Division of Pediatric Nephrology, Hospital de Cruces, Baracaldo, Vizcaya, Spain.
Pediatr Nephrol. 2009 Oct;24(10):2047-50. doi: 10.1007/s00467-009-1215-9. Epub 2009 Jun 3.
An 11-year-old girl, who was a renal transplant recipient, developed linear growth failure associated in time with sirolimus (SRL) treatment. After 5 years of functional graft [creatinine clearance (CCr) 90 ml/min per 1.73 m(2) body surface area], she developed acute renal failure due to calcineurin inhibitor-related hemolytic uremic syndrome, and cyclosporine A was replaced by SRL. Before the drug change, she had been growing normally (5.5 cm/year) and had reached the 33.9 percentile (P) of height (z-height -0.41), similar to her target. Two years later, her height had decreased to P 6th (z-height -1.54), as her growth velocity had diminished to 2.2 cm/year, despite optimal renal function (CCr 68 ml/min per 1.73 m(2)). Human recombinant growth hormone was needed to promote her catch-up growth and achieve the P 49th of height (z-height -0.03). SRL may have deleterious effects on growing children due its characteristic anti-proliferative and anti-angiogenic properties. Pediatric transplant recipients' linear growth should be cautiously monitored while they are being given SRL.
一名11岁的肾移植女童在接受西罗莫司（SRL）治疗后出现了线性生长迟缓。在移植肾具有功能的5年后[肌酐清除率（CCr）为每1.73平方米体表面积90 ml/min]，她因钙调神经磷酸酶抑制剂相关的溶血性尿毒症综合征而发生急性肾衰竭，环孢素A被SRL所取代。在更换药物之前，她生长正常（每年5.5 cm），身高达到第33.9百分位（P）（身高Z值为 -0.41），与她的目标相似。两年后，尽管肾功能良好（CCr为每1.73平方米体表面积68 ml/min），但她的身高降至第6百分位（P）（身高Z值为 -1.54），因为生长速度已降至每年2.2 cm。需要使用重组人生长激素来促进她的追赶生长，并达到身高第49百分位（身高Z值为 -0.03）。由于其具有抗增殖和抗血管生成特性，SRL可能对正在生长的儿童产生有害影响。在给小儿移植受者使用SRL时，应谨慎监测其线性生长情况。
