Recombinant Human Growth Hormone Therapy On Growth Retardation In Children With Nephrotic Syndrome

Purpose:Primary nephrotic syndrome(PNS)is one of the most common kidney diseases in children.Clinical manifestations are massive proteinuria,hypoproteinemia,edema and hypercholesterolemia.Disease condictions and use of glucocorticoid have caused more than 17.6%of children to suffer from growth retardation,which significantly affects children’s physical and mental health.However,there is no effective intervention strategies at present.Therefore,it is necessary to seek ways to prevent growth disorders in children with PNS.In this study we aim to investigate the epidemiological characteristics of growth disorders in children with PNS and the efficacy and safety of recombinant human growth hormone(rhGH)in the treatment of short stature in PNS children.Methods:(1)Height measurment was performed on 229 children who were diagnosed as PNS in the General Hospital of the Eastern People’s Liberation Army from July 2016 to December 2017.And Medical histories were collected for retrospective analysis.(2)To observe the therapeutic effects of rhGH in the treatment of rhGH in PNS children,29 children were enrolled.21 used rhGH were as treatment group(15 males,6 females)mean age is(9.8±2.3)years;8 patients without treating with rhGH were as Control group(6 males,2 females)mean age(10.5±5.9)years.The treatment group were subcutaneous injected rhGH 0.1-0.15IU/kg/day.Then the times of recurrences pre-,after-growth hormone in tremtment group were compared and the incidence rate of adverse reactions after rhGH treatment were calculated.When the rhGH treatment peroids reach 7 month,we further compared the variation of height standard deviation scores(HTSDS)pre-and after rhGH treatment in these patients.Then compared the variation of HTSDS and the growth velocity(GV)with control group.Results:(1)In 229 children with PNS,33 children were diagnosed short stature(HTSDS<-2SDS),counting for 14.4%;-2SDS<HTSDS<-1SDS for 50 cases at 21.8%;-1SDS<HTSDS≤0SDS for 62 cases at 27.1%;HTSDS>0SDS counting for 84 cases at 36.7%;A lot part of HTSDS in PNS behind normal condition.(2)15 children with rhGH treatment more than seven months(7 months group),Pre-growth hormone HTSDS(HTSDS 1)increased after rhGH therapy for 7 months(HTSDS2),HTSDS of the last time during rhGH treatment(HTSDS3)and more close to genetic HTSDS(-2.3±0.8)SDS,(-1.8±0.1)SDS,(-1.4±1.2)SDS,(-0.5±0.5)SDS,HTSDS1 were significantly less than HTSDS2,HTSDS3 and genetic HTSDS(P<0.05).Body mass index standard deviation score 1(BMISDSl)decrease after 7 months of rhGH treatment(BMISDS2)at(1.2±1.5)SDS,(0.5±1.2)SDS(P<0.05);(3)The GV of the 7 months group increased significantly than the control group at(8.3±3.4)cm/year and(4.4±3.1)cm/year(p<0.01),and so as the HTSDS at:(0.7±0.7)SDS/year,(0.0+0.7)SDS/year,(P<0.05);(4)IGF-1,TSH,GLU and TG of pre-growth hormone were:(273.0±83.6)ug/L,(3.0±1.8)mIU/L,(4.4±0.6)mmol/L,(4.4±0.9)μmol/L,after rhGH treatment were:(414.7±134.3)ug/L,(2.5±1.0)mIU/L,(4.7±0.5)mmol/L,(4.2±1.0)μmol/L respectly;IGF-1 was increaesd(P<0.05),and so as GLU(P<0.05);(5)The recurrences pre-and after treatment in 21 cases of rhGH treatment group was no differences(P>0.05),2 cases had rash(9.5%)during rhGH treatment,and 1 case showed macroscopic hematuria(4.8%),1 case of urinary microscopic hematuria(4.8%),2 cases of calf pain(9.5%),and 3 cases of scoliosis(14.2%).Conclusion:The incidence of short stature in children with nephrotic syndrome is 14.4%.rhGH can effectively improve the GV of children with PNS,but the incidence of scoliosis is relatively common.Side effects were also relatively high,The indications of rhGH treatment of PNS children should be treated seriously.