Changes in bone histomorphometry during treatment with recombinant human growth hormone in children with dialysis
Małgorzata Pańczyk-Tomaszewska, Andrzej Dębiński, Helena Ziółkowska, Beata Leszczyńska, Zofia Polowiec, Andrzej Sawicki, Maria Sieniawska
Med Sci Monit 1998; 4(6): CR966-974
The aim of the study was an evaluation of changes in histomorphometric parameters in children with chronic renal failure (crf) during therapy with recombinant human growth hormone (rhGH) and the attempt to determine the relationship between the type of uraemic osteodystrophy, the level of parathormone (in-PTH) and growth rate. The study was performed on 15 dialysed children aged 3.8-13.9 years (mean age 10.83±2.65) divided into 2 groups: in group I, we used dialysis fluids with 1.25 mmol/l calcium, while in group II, dialysis fluids contained 1.75 mmol/l calcium. Before and after one-year treatment with rhGH, biopsy of iliac ala was performed and the following were determined: the level of parathormone (inPTH), osteocalcine (OC), alkaline phosphatase (AP), calcium and phosphorus in blood serum. Before the beginning of treatment with rhGH, the biopsy revealed the following: adynamic bone disease (ABD) in 4 cases, hyperparathyroidism (HP) in 5, normal bone histology (NB) in 3 children as well as 1 case of osteomalacia(OM), mixed lesion (Mix) and osteoporosis (OP). The second bone biopsy allowed to detect the following: ABD in 2 children, HP in 6, NB in 5 as well as 1 case of OM and Mix. Varied osteoclast surface (Oc. S/BS), osteoblast surface/osteoid surface (Ob. S/OS) as well as inPTH, OC, AP were observed after one year of treatment. Patients from group I demonstrated significant increase in bone volume (BV/TV), osteoid volume(OV/BV), Ob. S/BS, Oc. S/BS, while in patients from group II, there was a significant decrease in OV/BV after one-year therapy with rhGH. The increase in body length was 4.4-12.4 cm per year, on the average 8.29±2.24 cm. We observed neither the effect of the type of uraemic osteodystrophy upon growth rate nor the correlation between growth rate and DSDS for body growth and mean annual PTH level during the treatment with rhGH.
Conclusions: Changes in histomorphometric parameters of bones during the treatment with rhGH may depend upon the activity of growth hormone but also on changes in serum PTH as well as alfacalcidol and calcium supplies. Type of uraemic osteopathy does not influence growth rate in children with crf during treatment with rhGH. The study has been partially sponsored by M. Curie-Skłodowska Foundation - MCS1.
Keywords: renal disease, treatment, bone histomorphometry, Growth Hormone, osteocalcine, parathormone, Alkaline Phosphatase