The effects of prolonged substitution of recombinant human growth hormone on renal functional reserve in growth hormone-deficient adults.

Abstract

Twelve growth hormone (GH)-deficient adults with normal renal function were recruited for a 6-month, double-blind, placebo-controlled study on the effects of prolonged recombinant human growth hormone (rhGH) substitution therapy on renal functional parameters. RhGH was administered at a dose 0.125 IU/kg per week sc the first 4 wk and 0.25 IU/kg per week thereafter. At baseline and after 6 months of therapy, GFR and RPF were measured by the use of iothalamate and para- aminohippurate clearance techniques before and after an intravenous infusion of amino acids (AA) to determine the renal functional reserve capacity (RFRC). At baseline, GFR and RPF were similar in the GH-deficient patients and a group of normal, healthy controls (GFR, 117 +/- 10 mL/min; RPF, 567 +/- 57 mL/min, and filtration fraction, 22 +/- 1.6% in the patient group and GFR, 117 +/- 10 mL/min; RPF, 509 +/- 54 mL/min; and filtration fraction, 24 +/- 1.3% in the control group). GFR increased significantly in the control and patient group after AA infusion; the RFRC, however, was significantly larger in healthy individuals (GFR post-AA infusion, 141 +/- 10 mL in GH-deficient patients and 182 +/- 20 mL/min in controls). Thereafter, six patients received placebo therapy for 6 months and GFR as well as RFRC remained constant (GFR, 107 +/- 9 and 106 +/- 12 mL/min before AA infusion and 132 +/- 14 and 134 +/- 5 mL/min after AA infusion at baseline and after 6 months, respectively). Four patients of the placebo group then continued with rhGH therapy for another 6 months. They and six patients who had rhGH therapy from the beginning form the rhGH treatment study group. During rhGH treatment, plasma insulin-like growth factor activity increased significantly from 93 +/- 17 to 229 +/- 23 ng/mL. Baseline GFR and RPF as well as RFRC were unaltered by the 6 months of rhGH replacement therapy (basal GFR, 124 +/- 7 mL/min before and 123 +/- 9 mL/min after 6 months of rhGH therapy; GFR after AA infusion, 145 +/- 9 mL/min at baseline and 144 +/- 8 mL/min after 6 months of therapy). Kidney size as evaluated by ultrasonography was normal at baseline when compared with that in age- and sex-matched controls (10.3 +/- 0.2 versus 9.9 +/- 0.1 cm) and was unchanged after 6 months of therapy (10.3 +/- 0.3 cm). It was concluded from this study that rhGH substitution for 6 months at a dose of 0.25 IU/kg per week in GH-deficient patients with normal renal function has no adverse functional effects on the kidney.