Pediatr Nephrol. 2013 Jan;28(1):1-4. doi: 10.1007/s00467-012-2293-7. Epub 2012 Sep 5.
Growth retardation remains a clinical problem in children with chronic kidney disease (CKD) prior to and during end-stage renal disease. The growth of approximately 40 % of children on dialysis is stunted. Even so, growth hormone treatment (GH) is not used in the majority of small children prior to transplantation. Also, GH is effective in improving growth after transplantation, but again, it is only rarely used in this situation mainly for fear of triggering rejection episodes. In controlled studies, the number of patients who developed rejection episodes with GH was no greater than the number in untreated controls. However, patients with prior frequent rejection episodes developed further repeated subsequent rejection episodes. Many patients with repeated rejection episodes before GH treatment have reduced renal function and are expected to proceed to dialysis or retransplantation. We believe that in these patients, early individual decisions for or against GH treatment should be made as soon as other treatment strategies, such as steroid withdrawal, have failed or are not indicated. Decisions for GH treatment at a later pubertal age come too late for significant growth response and/or improvement of final height.
生长迟缓仍然是慢性肾脏病（CKD）儿童在终末期肾病之前和期间的一个临床问题。大约 40%的透析儿童的生长发育迟缓。即便如此，在移植前，大多数小患儿并未使用生长激素治疗（GH）。此外，GH 在移植后改善生长是有效的，但同样，由于担心引发排斥反应，这种情况很少使用。在对照研究中，发生排斥反应的患者数量与未接受治疗的对照组患者数量相同。然而，有既往频繁排斥反应的患者出现了进一步的反复后续排斥反应。许多在 GH 治疗前有反复排斥反应的患者肾功能降低，预计将进行透析或再次移植。我们认为，在这些患者中，一旦其他治疗策略（如停用类固醇）失败或不适用，应尽早针对 GH 治疗做出个人决定。GH 治疗的决定在后期青春期年龄做出，对于显著的生长反应和/或最终身高的改善为时已晚。
