Abstract

The aim of the study was to estimate the changes in bone formation markers (procollagen lC - PICP0, osteocalcin - OC, alkaline phosphatase - AP) and parathormone (PTH intact) in children with end-stage renal disease during the first 6 months of recombinant human growth hormone (rhGH) treatment. 13 children, aged 6-13 years were included in the study, 7 on haemodialysis (HD) and 6 on continuous ambulatory peritoneal dialysis (CAPD). The patients received rhGH (1-1.1 IU/kg/week s.c.), alfacalcidol (0.038-0.13 mg/kg body weight/week) and calcium carbonate (50-150 mg/kg body weight/day). Morphometric analysis of iliac crest bone performed in 12 children prior to rhGH treatment revealed osteitis fibrosa in 1 case (8.3%), mild lesion of secondary hyperparathyroidism in 8 cases (66.8%), adynamic bone disease in 1 case (8.3%) and normal histology in 2 (16.6%). The height increment after 6 months was 3.2-5.9 cm in 11 children and 0.8 cm in 1 child. In the first 3 months of treatment the PICP concentrations increased in 11 children, but the OC levels increased in 5 children only. After 6 months the OC levels increased in 11 children. The AP activity increased in 9 out of 13 patients. In 7 children the levels of intact PTH were 7 to 24 times higher that the baseline levels, exceeding 200 mg/ml. The increased PTH levels were probably the result of inadequate dosage of vitamin D active metabolite in children with improved growth velocity.

Keywords: end-stage renal disease, recombinant human growth hormone, parathormone, osteocalcin, procollagen lC