It is now quite clear that treatment with growth hormone improves growth in growth retarded children with chronic kidney disease. However, the basis for the so-called growth hormone "resistance" of children with kidney failure has not been elucidated. From studies in other (adult) disease states, we know that the biological effects of high cytokine levels on the growth hormone-insulin-like growth factor axis parallel the growth hormone protein abnormalities seen in children with kidney failure. This suggests the possibility that cytokines contribute to the growth hormone "resistance" of children with kidney failure. There is a great deal of information (in adults) substantiating the fact that alterations in cytokine production starts early in the course of renal failure well before dialysis is initiated. Recent data links a number of cytokines to the growth hormone axis proteins through a potentially common regulatory pathway by way of the Suppressor of Cytokine Signaling Proteins. These proteins are induced by cytokines and block cytokine initiated signal transduction within the cytokine producing cells through classical negative feedback loops. However, there is almost no cytokine data in children with kidney failure. We are studying the role that cytokines play in regulation of growth in growth retarded children with chronic kidney disease.
We are also continuing to evaluate novel therapies for the treatment of Focal Segmental Glomerulosclerosis and Membranoproliferative Glomerulonephritis in children.
We are participating in trials of anti-hypertensive medications in children with high blood pressure and management of anemia in chronic kidney disease.