Abstract: Background: Treatment of idiopathic glomerular diseases often faces several challenges, namely low
initial response, relapse of the disease during/after reduction or withdrawal of the therapy and side effects or
prohibitive cost of the medicines. These have led to a research for second, third or fourth line therapies to attain
sustained remission, at the same time avoiding complications. ACTH was employed many years ago for the
treatment of nephrotic syndrome in children and adults. It has been reappraised, due to its efficacy in reducing
proteinuria and lipids in cases of glomerulonephritis resistant to conventional treatment with steroids and
immunosuppressive. This effect has persisted for several patients many months after the discontinuation of treatment.
ACTH has reemerged as a potential treatment option in a variety of glomerular diseases, including those which have
initially shown a less than satisfactory response to the usual therapies in idiopathic nephrotic syndrome. Aim of the
Work: is to evaluate different therapeutic modalities given to those patients and asses the response and efficacy of
treatment and determine if the patient need treatment with ACTH as primary treatment or for resistant cases.
Patients and Methods:. 77 patients presented with proteinuric nephropathies with no history of diabetes
mellitus,chronic kidney disease and HCV were subjected to complete history taking, thorough clinical examinations,
laboratory investigations, abdominal ultrasonography and they will be classified according to the pathology present
in the renal biopsy into groups (minimal change nephropathy- membranous GN- focal segmental
glomerulosclerosis- membranoproliferative GN-lupus nephritis stage III-IV-V-thrombotic microangiopathy) Each
group was subdivided into three subgroups one group had received ACTH only-one group had received ACTH plus
conventional therapy-and one group had received conventional therapy only –all groups had received non specific
measures of reduction of proteinuria as ACEI or ARBS and statins. ACTH was given as intramuscular injection
according to the body weight(8,3-30microgram/kg) twice weekly with most patients receive average 1 mg in dose as
primary therapy- secondary therapy –as adjuvant therapy –and after failure of other immunosuppressives for
resistant cases Results: 27 of 77 patients (35%) achieved a complete remission and 26 of 77 patients achieved
partial remission (33%) total 68%. Of the 53 patients who achieved complete or partial remission, 12 had IMN, 14
had FSGS, and 8 had minimal change nephropathy and 13 patients with lupus nephritis 6 patients with MPGN. In
IMN9 of 12 patients received ACTH either as monotherapy or as adjuvant therapy with response rate of 75% -5
patients were on ACTH only show remission rate 41% - 3patients were on conventional therapy show remission rate
25%.in FSGS 10 of 14 patients received ACTH either as monotherapy or as adjuvant therapy with response rate of
71% -4 patients were on ACTH only show remission rate 28% - 4 patients were on conventional therapy show
remission rate 28%. In MCN 6 of 8 patients received ACTH either as monotherapy or as adjuvant therapy with
response rate of 75% -3 patients were on ACTH only show remission rate 37% - 2 patients were on conventional
therapy show remission rate 25%. In MPGN2 of 6 patients received ACTH either as monotherapy or as adjuvant
therapy with response rate of 33% -2 patient was on ACTH only show remission rate 17 % - 4 patients were on
conventional therapy show remission rate 66%. Conclusion: Synthetic ACTH can be used in treatment of
proteinuric nephropathies as primary therapy especially in podocytopathies and in membranous nephropathy and as
adjuvant therapy in lupus nephritis and in resistant cases after failure of other immunosuppresives
[El-Metwaly Lotfy El-Shahawy, Mohammed El-Sayed Salem, Sameh Bahgat Hannalla, Hassan Galal Abdelsalam
and Ahmed Ezzat Mansour. Melanocortin Receptor Agonist (Corticotrophin) in Treatment of Proteinuric
Nephropathies. Nat Sci 2015;13(9):41-49]. (ISSN: 1545-0740). http://www.sciencepub.net/nature. 8 |
