Maxwell H, Dalton R N, Nair D R, Turner C, Saunders A J, Rigden S P, Rees L
Department of Paediatric Nephrology, Royal Free Hospital, Hampstead, London, United Kingdom.
J Pediatr. 1996 Feb;128(2):177-83. doi: 10.1016/s0022-3476(96)70386-4.
To provide accurate measurement of renal function during treatment with recombinant human growth hormone (rhGH).
We measured glomerular filtration rate and effective renal plasma flow by clearance of inulin and para-aminohippuric acid before rhGH therapy, after 1 week, and then at 6-month intervals for up to 2 years of treatment in 16 children (mean (SD) age = 13.1 (2.2) years; glomerular filtration rate = 52 (27) ml/min per 1.73 m2). The mean (SD) time from transplantation was 6.5 (3.6) years.
Linear growth velocity during rhGH therapy increased from 4.0 (1.8) to 8.8 (2.6) cm/yr (p < 0.0001). One child was withdrawn after 9 months because of abnormal glucose tolerance, and another child received a second renal transplant after 18 months. Glomerular filtration rate increased to 57 (29) ml/min per 1.73 m2 at 1 week (p = 0.004), remained improved at 6 months (63 (30); p = 0.013), but was not significantly better at 1 year (59 (33)). Effective renal plasma flow on day 1 was 237 (127) ml/min per 1.73 m2 and was unchanged on day 8 (244 (123)), at 6 months (271 (149)), and after 1 year (269 (157)). During the study there was no significant change in filtration fraction, blood pressure, or kidney volume, and excretion of microalbumin and N-acetylglucosaminidase was unaltered. There was one rejection episode per 14.8 patient-months in the year before treatment, 1 per 18.9 patient-months during the first year of treatment, and 1 per 13 patient-months during the second year of rhGH therapy.
Treatment with rhGH improves growth in children with renal transplants. Glomerular filtration rate was increased after 1 week and 6 months of rhGH therapy but returned to baseline values thereafter. The data indicate the need for long-term follow-up of children with renal transplants who are receiving rhGH.
准确测量重组人生长激素（rhGH）治疗期间的肾功能。
我们在16名儿童（平均（标准差）年龄 = 13.1（2.2）岁；肾小球滤过率 = 52（27）ml/（min·1.73 m²））中，于rhGH治疗前、治疗1周后，以及之后每6个月测量一次菊粉清除率和对氨基马尿酸清除率，以测定肾小球滤过率和有效肾血浆流量，治疗时间长达2年。移植后的平均（标准差）时间为6.5（3.6）年。
rhGH治疗期间的线性生长速度从4.0（1.8）增加至8.8（2.6）cm/年（p < 0.0001）。1名儿童在9个月后因糖耐量异常退出，另1名儿童在18个月后接受了第二次肾移植。肾小球滤过率在1周时增至57（29）ml/（min·1.73 m²）（p = 0.004），6个月时仍保持改善（63（30）；p = 0.013），但1年时无显著改善（59（33））。第1天的有效肾血浆流量为237（127）ml/（min·1.73 m²），第8天（244（123））、6个月时（271（149））和1年后（269（157））均无变化。研究期间，滤过分数、血压或肾脏体积无显著变化，微量白蛋白和N - 乙酰氨基葡萄糖苷酶的排泄也未改变。治疗前每年每14.8患者 - 月有1次排斥反应，rhGH治疗第1年每18.9患者 - 月有1次，第2年每13患者 - 月有1次。
rhGH治疗可改善肾移植儿童的生长情况。rhGH治疗1周和6个月后肾小球滤过率升高，但此后恢复至基线值。数据表明，接受rhGH治疗的肾移植儿童需要长期随访。
