title: ACTH and azathioprine: antiproteinuric and lipid-lowering effect in the course of idiopathic membranous glomerulonephritis.
abstract: Idiopathic membranous glomerulonephritis is a frequent cause of nephrotic syndrome and may have a variable course, from spontaneous remission to progression on renal failure. The therapy is based on alternating steroids and chlorambucil or cyclophosphamide (Ponticelli protocol) for six months. In absence of complete or partial remission after protocol, cyclosporine, adrenocorticotropic hormone, mycophenolate mofetil, rituximab can be used for potential therapy. We report here the case of a woman with idiopathic membranous glomerulonephritis unresponsive to the Ponticelli regimen and treated with adrenocorticotropic hormone in association with azathioprine, showing a dramatic decrease of proteinuria and beneficial effects on lipid profile. After 36 months, no relapse of disease has occurred. Although larger cohorts of patients are needed to evaluate the long-term effects, adrenocorticotropic hormone plus azathioprine in association could be a possible therapeutic option for unresponsive idiopathic membranous glomerulonephritis.
authors.forename: A
authors.initials: A
authors.lastname: Gigante
authors.forename: E
authors.initials: E
authors.lastname: Rosato
authors.forename: M
authors.initials: M
authors.lastname: Liberatori
authors.forename: M L
authors.initials: ML
authors.lastname: Gasperini
authors.forename: K
authors.initials: K
authors.lastname: Giannakakis
authors.forename: B
authors.initials: B
authors.lastname: Barbano
authors.forename: R
authors.initials: R
authors.lastname: Cianci
authors.forename: F
authors.initials: F
authors.lastname: Salsano
authors.forename: A
authors.initials: A
authors.lastname: Amoroso
mesh_terms: D000324:Adrenocorticotropic Hormone / Q000627:therapeutic use*; D000368:Aged; D001379:Azathioprine / Q000627:therapeutic use*; D002699:Chlorambucil / Q000627:therapeutic use; D003520:Cyclophosphamide / Q000627:therapeutic use; D005260:Female; D015433:Glomerulonephritis, Membranous / Q000150:complications / Q000188:drug therapy*; D006801:Humans; D011507:Proteinuria / Q000188:drug therapy / Q000209:etiology; D017211:Treatment Failure; D016896:Treatment Outcome
chemical_list: D002699:Chlorambucil; D003520:Cyclophosphamide; D000324:Adrenocorticotropic Hormone; D001379:Azathioprine