Endocrine Abstracts

Introduction: Multiple factors have been incriminated in growth retardation in patients with chronic kidney disease (CKD), such as metabolic acidosis, anemia, vitamin D deficiency with secondary hyperparathyroidism, under-nutrition, renal bone disease. The disease compromises vertical growth with up to one-third children having severe growth delay (below the third percentile for height). Optimal care and nutritional therapy alone, can’t help the children with CKD reach their normal height without the supplemental growth hormone therapy.

Case report: An 11-year old male, known with chronic renal failure since birth, renal osteodistrophy with right renal transplant, came into our clinic for initiation of recombinant growth hormone(rGH) therapy. At the time, height was 126 cm (−3.32 DS), with a weight of 31 kg, in pubertal stage with bone age of 9 years. Predicted adult height was 165 cm, and midparental height was 180 cm. Metabolic bone parameters allowed us to initiate the rGH treatment. The additional question raised in that moment was related to the skeletal status: the patient had bilateral femoral neck fracture treated conservatively and in DXA whole body scan had a TBLH Z score of −3.84 which completed the diagnosis of osteoporosis. The patient had secondary hyperparathyroidism, in the context of CKD( GFR = 46.9 ml/min per 1.73 m²) and previous chronic corticotherapy which recommended also byphosphonate( BF) initiation together with active vitamin D metabolites. We decided to postpone the BF therapy. Bone mass density reevaluation showed improvement under rGH treatment and 1-alpha-calcidol; thus after 1.5 years of rGH treatment, the TBLH Z score was −1.2 and without new fractures.

Conclusions: Despite not reaching the optimal height under rGH treatment period, we were able to improve bone mass density of the patient, which might be a certain benefit of it.