losartan-potassium and Growth-Disorders

Chronic renal failure, dialysis and transplantation have major effects on male reproductive health because of the impairment of spermatogenesis, steroidogenesis and sexual function. Hypothalamo-pituitary testicular dysfunction in uraemia is manifest clinically as delayed growth and puberty, sexual dysfunction, androgen deficiency, impaired spermatogenesis and infertility. Apart from renal anaemia, there are at present no proven indications for androgen therapy in chronic renal failure. This chapter reviews the basis and scope for various clinical applications of gonadotropin and androgen therapy as an adjunct to the standard medical care of chronic renal failure. The therapeutic possibilities implied by experimental and clinical findings suggesting that uraemic hypogonadism may be a functional state of gonadotropin deficiency are emphasized.

Topics: Anemia; Clinical Trials as Topic; Enuresis; Erythropoietin; Gonadotropins; Growth Disorders; Humans; Infertility, Male; Kidney Failure, Chronic; Male; Puberty, Delayed; Sleep Apnea Syndromes; Testosterone

Topics: Anemia; Child; Erythropoietin; Growth Disorders; Growth Hormone; Humans; Kidney Failure, Chronic; Recombinant Proteins

Topics: Animals; Blood Viscosity; Cardiovascular Diseases; Central Nervous System Diseases; Erythrocyte Deformability; Erythropoietin; Female; Fetal Hypoxia; Fetofetal Transfusion; Fetomaternal Transfusion; Fetus; Follow-Up Studies; Gastrointestinal Diseases; Genital Diseases, Male; Global Health; Growth Disorders; Hematocrit; Humans; Hyperbilirubinemia; Hypocalcemia; Hypoglycemia; Infant, Newborn; Infant, Small for Gestational Age; Kidney Diseases; Male; Mental Disorders; Polycythemia; Pregnancy; Pregnancy Complications, Hematologic; Pregnancy in Diabetics; Prognosis; Respiration Disorders; Sheep; Thrombocytopenia

Several reports suggest a role of growth hormone (GH) in the regulation of the haematopoietic system, as regards the normal differentiation and function of blood cells. The aim of this study was to evaluate the influence of rhGH therapy on erythropoietin (Epo) and granulocyte-colony stimulating factor (G-CSF) levels in 18 prepubertal short children with idiopathic GH deficiency (GHD) (n = 8) or without GHD (n = 10), during the first year of treatment. In non-GHD children Epo levels significantly decreased and G-CSF levels increased from basal to 12 months of therapy, whereas in GHD children they did not change significantly. Circulating levels of G-CSF are significantly lower in GHD than in non-GHD children. In non-GHD children the number of red blood cells, haemoglobin and haematocrit values significantly increased after 1 year of rhGH treatment. rhGH therapy influences Epo and G-CSF levels in short non-GHD children, while it shows no effects in GHD children.

Topics: Adolescent; Adolescent Development; Age Determination by Skeleton; Body Height; Child; Child Development; Erythropoietin; Female; Granulocyte Colony-Stimulating Factor; Growth Disorders; Hormone Replacement Therapy; Human Growth Hormone; Humans; Male; Pilot Projects; Recombinant Proteins

Intravenous recombinant human erythropoietin (Eprex Cilag) was used in 28 hemodialyzed children, treated in 3 French paediatric centers, from November 1989 to November 1990. Transfusion dependency disappeared in all cases: the number of transfusions decreased from 7.3 unit/patient/year to 0.6 unit/pt/year. The mean haemoglobin concentration for the whole group increased from 6.6 +/- 0.8 g/dl, to 9.2 +/- 1.2 at 6 months and 9.7 +/- 0.7 g/dl at 1 year. Twenty-two out of 28 children reached the target haemoglobin value of 9.6 g/dl (6 mmol/dL) within a mean time of 16.5 weeks. Poor responses were due to either a premature withdrawal of treatment because of renal transplantation, or too low a dosage for the age. The study showed indeed that the dose requirement was significantly dependent on physical development: the mean dosage required to maintain haemoglobin concentration at the target value was 300 U/kg/week in children weighing less than 20 kg, 222 U/kg/week in 20-30 kg children, and 135 U/kg/week in those weighing more than 30 kg (p = 0.02). The only complication was an increase in blood pressure, observed in 43% of cases. The increase of anti-hypertensive medication was always successful in controlling blood pressure, and hospitalization was required in only one case. The improvement in general condition was obvious, and in several cases, the cognitive abilities seemed to improve. The growth deficit remained unchanged.

Topics: Adolescent; Anemia; Appetite; Blood Transfusion; Body Weight; Child; Child, Preschool; Cognition Disorders; Dose-Response Relationship, Drug; Erythropoietin; Female; France; Growth Disorders; Hemoglobins; Humans; Hypertension; Immunologic Factors; Infant; Kidney Failure, Chronic; Male; Recombinant Proteins; Renal Dialysis; Treatment Outcome

Short-term lower leg length was measured longitudinally using a high-precision device called a knemometer in 11 children with chronic renal failure and 12 normal children. The method has a high accuracy (mean standard error 0.13 mm) and may prove useful for prediction of long-term total body growth. Its application in renal patients undergoing corticosteroid, growth hormone (GH) and erythropoietin (EPO) therapy is documented. GH was shown to improve lower leg growth in an adolescent who already had passed the maximum of his pubertal spurt. EPO treatment produced no consistent increase of short-term growth.

Topics: Adolescent; Anthropometry; Body Height; Child; Child, Preschool; Erythropoietin; Female; Growth Disorders; Growth Hormone; Humans; Kidney Failure, Chronic; Kidney Transplantation; Leg; Male; Recombinant Proteins

Long-term steroid therapy has a depressant effect on hypothalamo-pituitary pulsatile secretion of growth hormone (GH), and this results in an attenuated pubertal growth spurt. Oxandrolone and recombinant human GH improve growth rates in children taking long-term steroid therapy for renal disease, but there are potential side effects. Treatment with recombinant human erythropoietin improved the growth of three prepubertal, but not three pubertal haemodialysis patients.

Topics: Adolescent; Anemia; Child; Child, Preschool; Erythropoietin; Growth; Growth Disorders; Growth Hormone; Humans; Kidney Failure, Chronic; Kidney Transplantation; Oxandrolone; Recombinant Proteins; Renal Dialysis; Steroids

Topics: Adult; Androgens; Androstanes; Anemia, Hemolytic; Bone Marrow Diseases; Child; Erythropoiesis; Erythropoietin; Female; Growth Disorders; Hematologic Diseases; Hematopoiesis; Humans; Kidney Failure, Chronic; Male; Virilism

Topics: Adipose Tissue; Animals; Biological Assay; Cartilage; Cell Division; Cell Membrane; Chick Embryo; Erythropoietin; Growth Disorders; Growth Substances; HeLa Cells; Humans; Insulin; Muscles; Nerve Growth Factors; Rats; Somatomedins