Case series of idiopathic membranous nephropathy with long-term beneficial effects of ACTH peptide 1-24.
BACKGROUND
In patients with idiopathic membranous nephropathy (IMN), immunosuppressive therapy is usually considered when severe nephrotic syndrome or risk for progressive renal failure exist. Recently, several studies showing beneficial effects of synthetic adrenocorticotropic hormone (ACTH) under such circumstances have been published. The objective of the present case series was to evaluate long-term ACTH effects on proteinuria and renal function.


METHODS
Four patients with biopsy-proven membranous nephropathy and nephrotic syndrome were enrolled (median age 50 years (range 38 - 61), median GFR 39.5 ml/min (range 20 - 62), median proteinuria 9.6 g/d (range 6.0 - 20.0). Prior immunosuppressive treatment regimens included steroids, cyclosporine A, cyclophosphamide, mycophenolate mofetil or azathioprine. The patients received a synthetic ACTH analogue intramuscularly for a median duration of 8 months (range 3 - 24). ACTH dosage was adjusted according to side effects between 0.25 and 2.25 mg/week. Follow-up lasted between 24 and 82 months after therapy initiation.


RESULTS
All 4 patients exhibited partial (n = 2) or complete (n = 2) remissions of their nephrotic syndrome within the first year. After discontinuation of ACTH therapy, proteinuria remained low in 3 of 4 cases, whereas 1 patient exhibited undulating proteinuria. Glomerular function (as assessed by glomerular filtration rate, GFR) was maintained in all patients. Side effects were minor and included weight gain, elevated blood pressure and hyperglycemia.


CONCLUSIONS
In all 4 cases with IMN, ACTH treatment induced a lasting disease remission with relatively few side effects.
Rauen
T
T
Department of Nephrology and Clinical Immunology, RWTH-University Hospital, Aachen.
Michaelis
A
A
Floege
J
J
Mertens
P R
PR
D000328:Adult; D003366:Cosyntropin / Q000008:administration & dosage*; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate / Q000187:drug effects; D015433:Glomerulonephritis, Membranous / Q000175:diagnosis / Q000188:drug therapy*; D006728:Hormones / Q000008:administration & dosage*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011507:Proteinuria / Q000175:diagnosis / Q000188:drug therapy; D012074:Remission Induction
D006728:Hormones; D003366:Cosyntropin