Departments of, Department of, Gastroenterology, Nutrition and Endocrinology, Osaka Women's and Children's Hospital, Izumi, Osaka, Japan.
Department of, Pediatrics, Yodogawa Christian Hospital, Osaka City, Osaka, Japan.
Pediatr Int. 2021 Jul;63(7):775-781. doi: 10.1111/ped.14514. Epub 2021 May 19.
Children born small for gestational age (SGA), particularly when associated with an extremely low birthweight (ELBW), have a higher risk of renal dysfunction. Growth hormone (GH) treatment is used to treat short-statured children born SGA; however, its effects on renal function remain elusive, especially in those born SGA with ELBW.
Short-statured children born SGA (N = 42) were included. Subjects were subdivided into two groups based on their birthweight: the ELBW group (N = 15) with a birthweight of <1,000 g, and the non-ELBW group (N = 27) with birthweights ranging between 1,000 and 2,500 g. The creatinine-based estimated glomerular filtration rates (eGFR) before (pre-eGFR) and 5 years after GH treatment (post-eGFR) were compared. Correlations between eGFR, anthropometric, or birth parameters, and cumulative GH dose were evaluated using Spearman's rank correlation coefficient.
The ELBW group had a lower pre- and post-eGFR than the non-ELBW group. Five-year GH treatment did not significantly reduce eGFR in either group. Post-eGFR was positively associated with gestational week and birthweight. However, the cumulative GH dose was not correlated with pre-eGFR, post-eGFR, or percentage change in eGFR (%ΔeGFR). The change in bodyweight standard deviation score during GH treatment was positively correlated with %ΔeGFR in the ELBW group.
The current results indicated that GH treatment was unlikely a risk for the reduction in eGFR in short-statured children born SGA. However, eGFR should be carefully monitored, especially in those born SGA with ELBW because these subjects had lower eGFR than non-ELBW subjects.
出生体重小于胎龄儿（SGA），尤其是极低出生体重儿（ELBW），其肾功能受损的风险更高。生长激素（GH）治疗用于治疗 SGA 出生的身材矮小儿童；然而，其对肾功能的影响仍不清楚，尤其是在 SGA 出生且体重较轻的儿童中。
纳入 SGA 出生的身材矮小儿童（N=42）。根据出生体重将受试者分为两组：出生体重<1,000 g 的 ELBW 组（N=15）和出生体重在 1,000 至 2,500 g 之间的非 ELBW 组（N=27）。比较 GH 治疗前（pre-eGFR）和治疗后 5 年（post-eGFR）的基于肌酐的估算肾小球滤过率（eGFR）。使用 Spearman 秩相关系数评估 eGFR、人体测量或出生参数与累积 GH 剂量之间的相关性。
ELBW 组的 pre-eGFR 和 post-eGFR 均低于非 ELBW 组。两组中 5 年 GH 治疗均未显著降低 eGFR。post-eGFR 与胎龄和出生体重呈正相关。然而，累积 GH 剂量与 pre-eGFR、post-eGFR 或 eGFR 变化百分比（%ΔeGFR）无关。GH 治疗期间体重标准差评分的变化与 ELBW 组的%ΔeGFR 呈正相关。
目前的结果表明，GH 治疗不太可能导致 SGA 出生的身材矮小儿童 eGFR 降低。然而，应该仔细监测 eGFR，尤其是在那些 SGA 出生且体重较轻的儿童中，因为这些儿童的 eGFR 低于非 ELBW 儿童。
