Beneficial effects of ACTH on the serum lipoprotein profile and glomerular function in patients with membranous nephropathy.
BACKGROUND
Previous studies have shown that short-term treatment with adrenocorticotrophic hormone (ACTH) has a strong and rapid lipid-lowering effect. In this long-term study of nephrotic patients with idiopathic membranous nephropathy, the influence of ACTH on the serum lipoprotein profile and glomerular function as well as the dose-effect relationship was investigated.


METHODS
Fourteen patients received ACTH intramuscularly at increasing doses during 56 days. Serum concentrations of lipids, lipoproteins, and apolipoproteins as well as variables of glomerular function were analyzed, and the side-effects were recorded. ACTH treatment, in the estimated optimal dosage, was then continued in five patients with severe steroid-resistant nephrotic syndrome. In these five patients, the total treatment period was 12 months, and the follow-up time after discontinuing treatment was 18 months.


RESULTS
Taking both the statistically significant therapeutic effects and the modest side-effects into consideration, the optimal dosage of ACTH was estimated to be 1 mg twice per week. At that dose, reductions by 30 to 60% in the serum concentrations of cholesterol, triglycerides, apolipoprotein B, and lipoprotein(a) were observed, whereas the serum concentrations of high-density lipoprotein cholesterol and apolipoprotein AI rose by 30 to 40%. In addition, the urinary albumin excretion decreased by 90%, and the glomerular filtration rate increased by 25%. Deterioration was observed in all cases when ACTH was discontinued after a treatment duration of 56 days. However, the five patients in whom ACTH therapy was resumed were still in remission 18 months after discontinuance of treatment.


CONCLUSIONS
In nephrotic patients with idiopathic membranous nephropathy, treatment with ACTH 1 mg twice per week was associated with significant long-term improvements in serum lipoprotein pattern and glomerular function.
Berg
A L
AL
Department of Nephrology and Institute of Laboratory Medicine, Lund University, Sweden.
Nilsson-Ehle
P
P
Arnadottir
M
M
D000324:Adrenocorticotropic Hormone / Q000008:administration & dosage*; D000328:Adult; D000368:Aged; D000419:Albuminuria / Q000097:blood / Q000188:drug therapy / Q000503:physiopathology; D001054:Apolipoproteins A / Q000097:blood; D001055:Apolipoproteins B / Q000097:blood; D008076:Cholesterol, HDL / Q000097:blood*; D008078:Cholesterol, LDL / Q000097:blood*; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D015433:Glomerulonephritis, Membranous / Q000097:blood / Q000188:drug therapy* / Q000503:physiopathology; D006801:Humans; D006854:Hydrocortisone / Q000097:blood / Q000652:urine; D006951:Hyperlipoproteinemias / Q000097:blood / Q000188:drug therapy / Q000503:physiopathology; D007678:Kidney Glomerulus / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D009404:Nephrotic Syndrome / Q000097:blood / Q000188:drug therapy / Q000503:physiopathology; D012709:Serum Albumin
D001054:Apolipoproteins A; D001055:Apolipoproteins B; D008076:Cholesterol, HDL; D008078:Cholesterol, LDL; D012709:Serum Albumin; D000324:Adrenocorticotropic Hormone; D006854:Hydrocortisone