Growth hormone and renal function

Summary: Recombinant human growth hormone (rhGH) has been recognized to be beneficial for improving growth retardation in uraemic children. the potential effect of growth hormone (GH) on renal haemodynamics results in an increase in glomerular filtration rate and renal plasma flow. However, in GH transgenic mice and uraemic rats treated with GH, GH has been reported to aggravate glomerular sclerosis and induce deterioration in renal function. Therefore, the potential of adverse effect of GH on deterioration in renal function has been of concern in uraemic children receiving rhGH. Growth hormone enhances protein anabolism and promotes a positive nitrogen balance. It is more likely that the anabolic effect of GH used at the conventional dose may reduce renal solute load and slow the progression of end-stage renal failure (ESRF) in rhGH-treated uraemic children. A low protein diet with adequate calories slows the deterioration of renal function in uraemic patients. the effects of GH on growth promotion, renal haemodynamics and protein anabolism are mainly mediated by insulin-like growth factor-I (IGF-I). Insulinlike growth factor-I enhances glomerular filtration rate and promotes glomerular hypertrophy, but IGF-I administration is unlikely to give rise to glomerular sclerosis. the efficacy and the safety of concomitant therapy of recombinant GH or IGF-I and low protein diet should therefore be considered in uraemic children.