title: Low-dose synthetic adrenocorticotropic hormone-analog therapy for nephrotic patients: results from a single-center pilot study.
abstract: BACKGROUND
  This report describes our experience using a low-dose synthetic adrenocorticotropic hormone (ACTH) analog for patients affected by nephrotic syndrome who had not responded to or had relapsed after steroid and immunosuppressive treatments.
  
  
  METHODS
  Eighteen adult nephrotic patients with an estimated glomerular filtration rate >30 mL/min were recruited. Histological pictures included ten of membranous nephropathy, three of membranous proliferative glomerulonephritis, three of minimal change, and two of focal segmental glomerular sclerosis. All patients received the synthetic ACTH analog tetracosactide 1 mg intramuscularly once a week for 12 months. Estimated glomerular filtration rate, proteinuria, serum lipids, albumin, glucose, and potassium were determined before and during the treatment.
  
  
  RESULTS
  One of the 18 patients discontinued the treatment after 1 month because of severe fluid retention, and two patients were lost at follow-up. Complete remission occurred in six cases, while partial remission occurred in four cases (55.5% responder rate). With respect to baseline, after 12 months proteinuria had decreased from 7.24±0.92 to 2.03±0.65 g/day (P<0.0001), and serum albumin had increased from 2.89±0.14 to 3.66±0.18 g/dL (P<0.0001). Total and low-density lipoprotein cholesterol had decreased from 255±17 to 193±10 mg/dL (P=0.01), and from 168±18 to 114±7 mg/dL (P=0.03), respectively. No cases of severe worsening of renal function, hyperglycemia, or hypokalemia were observed, and no admissions for cardiovascular or infectious events were recorded.
  
  
  CONCLUSIONS
  Tetracosactide administration at the dosage of 1 mg intramuscularly per week for 12 months seems to be an acceptable alternative for nephrotic patients unresponsive or relapsing after steroid-immunosuppressive regimens. Further studies should be planned to assess the effect of this low-dose ACTH regimen also in nephrotic patients not eligible for kidney biopsy or immunosuppressive protocols.
authors.affiliation: Nephrology Transplant Dialysis Unit (AOUP), Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Lorusso
authors.affiliation: Nephrology Transplant Dialysis Unit (AOUP), Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.
authors.forename: Anna
authors.initials: A
authors.lastname: Bottai
authors.affiliation: Nephrology Transplant Dialysis Unit (AOUP), Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.
authors.forename: Emanuela
authors.initials: E
authors.lastname: Mangione
authors.affiliation: Nephrology Transplant Dialysis Unit (AOUP), Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Innocenti
authors.affiliation: Nephrology Transplant Dialysis Unit (AOUP), Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.
authors.forename: Adamasco
authors.initials: A
authors.lastname: Cupisti
authors.affiliation: Nephrology Transplant Dialysis Unit (AOUP), Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.
authors.forename: Maria Francesca
authors.initials: MF
authors.lastname: Egidi
keywords: ACTH; CKD; Tetracosactide; glomerulonephritis; nephrotic syndrome; proteinuria