Beneficial effects of ACTH on the serum lipoprotein profile and glomerular function in patients with membranous nephropathy

Berg, Ansgar; Nilsson‐Ehle, Peter; Arnadottir, Margret

doi:10.1046/j.1523-1755.1999.00675.x

Cited by 98 publications

(106 citation statements)

References 24 publications

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“…It has also been demonstrated that administration of exogenous ACTH in man has beneficial effects on lipid metabolism. A pronounced and consistent decrease of plasma cholesterol and lowdensity lipoproteins (LDL) -cholesterol by 20-40% has been reported during ACTH treatment in healthy individuals (3,4), in steroid-treated patients with renal disease (5,6) and in hemodialysis patients (4,7). The hypolipidemic effect includes all apolipoprotein B (ApoB) -containing lipoproteins, i.e.…”

Section: Introductionmentioning

confidence: 65%

ACTH reduces the rise in ApoB-48 levels after fat intake

Skoog

Berggren-Söderlund

et al. 2007

Atherosclerosis

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Section: Introductionmentioning

confidence: 65%

ACTH reduces the rise in ApoB-48 levels after fat intake

Skoog

Berggren-Söderlund

et al. 2007

Atherosclerosis

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“…The available data are insufficient to draw any firm conclusions about the use of MMF for induction of remission and the relapse rate is quite high (39). Synthetic adrenocorticotropic hormone (ACTH; Synacthen), administered by intramuscular or subcutaneous injection at a dosage of 1 mg twice a week for 1 year, can significantly reduce proteinuria in patients with idiopathic MN (42), as confirmed by a randomized clinical trial (43). Similar results have been obtained with natural ACTH (Acthar gel) in a small observational study (44).…”

Section: What Treatment Regimens Are Effective and Safe For Patients mentioning

confidence: 99%

Glomerular Diseases

Ponticelli

Glassock

2014

Clinical Journal of the American Society of Nephrology

181

128

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SummaryMembranous nephropathy (MN) is an autoimmune disease usually associated with a nephrotic syndrome and it may progress to ESRD in the long term. Its etiology is often unknown (idiopathic MN), whereas other cases have a recognizable etiology (secondary MN). In idiopathic MN, the glomerular lesions are mainly caused by autoantibodies against a podocyte membrane protein, the M-type of phospholipase A2 receptor 1. The natural course of idiopathic MN is quite varied with spontaneous complete or partial remissions a relatively common occurrence. Patients with asymptomatic non-nephrotic proteinuria seldom progress and need only conservative management. Those with persistent full-blown nephrotic syndrome and those with declining renal function are candidates for specific treatment with any of several regimens. Cyclical therapy with alternating monthly intravenous and oral glucocorticoids combined with a cytotoxic agent can induce remission and preserve renal function in the long term. Cyclosporine or tacrolimus can induce remission, but relapses are frequent after the drug withdrawal. Mycophenolate mofetil monotherapy seems to be ineffective, but may be beneficial when administered together with steroids. The experience with adrenocorticotropic hormone, natural or synthetic, is limited to a few studies with short-term follow-up, but high rates of remission can be seen after prolonged treatment. A high rate of remission and good tolerance have also been reported with rituximab. Patients with moderate renal insufficiency may also benefit from treatment, but at a price of frequent and serious side effects. With these limitations in mind, idiopathic MN may be considered a treatable disease in many patients.

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“…In a study by Berg and colleagues (74,75), synthetic adrenocorticotropic hormone (ACTH) administered for 1 yr decreased proteinuria in patients with MN. More recently, Ponticelli et al (76) conducted a randomized pilot study comparing MTP plus a cytotoxic agent versus synthetic ACTH in 32 patients with MN.…”

Section: New Therapiesmentioning

confidence: 99%

Idiopathic Membranous Nephropathy

Fervenza

Sethi

Specks

2008

Clinical Journal of the American Society of Nephrology

133

123

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Idiopathic membranous nephropathy is still the most common glomerular disease associated with nephrotic syndrome. The greater the proteinuria, the greater the long-term risk for renal failure. In addition, patients who have membranous nephropathy with nephrotic syndrome have significant morbidity and mortality, in particular related to thromboembolic and cardiovascular complications. There is no specific treatment for membranous nephropathy. Supportive care with the use of diuretics and angiotensin-converting enzyme inhibitors in combination with angiotensin II receptor blocker is recommended, but these agents have only a limited effect. Immunosuppressive treatment options include the use of corticosteroids, alkylating agents, cyclosporin A, tacrolimus, and mycophenolate mofetil, but their use is controversial, not all have been shown to be effective, and their use can be associated with significant adverse effects. This has resulted in relatively small improvement in the prognosis of membranous nephropathy in the past 30 yr, with up to 40% of patients eventually reaching end-stage renal failure. Agents that offer more complete response rates with lower adverse effects are truly needed. Recent data suggest that B cells play a key role in the pathogenesis of a number of autoimmune diseases including membranous nephropathy and that selective depletion of B cells in humans may be beneficial in preventing the production of pathogenic immunoglobulins and subsequent renal injury.Clin Case PresentationA 32-yr-old man underwent a general medical examination at his primary care physician's office in February 2004. At that time, he was noted to have elevated total cholesterol of 353 mg/dl and triglycerides of 417 mg/dl and was started on simvastatin 40 mg/d. During the course of the next 2 mo, he started developing swelling in his feet and ankles that proceeded to involve his calves. He also developed tenderness on his left calf. A diagnosis of a deep venous thrombosis was made, and he was started on oral anticoagulant therapy. Given the increased lower extremity edema, a urinalysis was conducted, and the patient was found to have significant proteinuria, with a 24-h urine collection showing proteinuria of 9.3 g. The patient had no history of diabetes, macroscopic hematuria, or hypertension. The patient underwent extensive serologic workup including monoclonal protein studies, serum complement levels, anti-neutrophil cytoplasmic antibodies, hepatitis B and C and HIV serology, and anti-nuclear antibody, all of which were negative or in the normal range, and in July 2004, he was referred to our institution for further evaluation. At presentation at the Mayo Clinic, the physical examination was of a healthy-appearing young man. His BP was 136/87 mmHg, pulse rate was 69, weight was 89.8 kg, and body mass index was 29 kg/m 2 . Eyes, nose, and throat examination was normal.There was no lymphadenopathy. Heart examination showed regular rate and rhythm with no murmurs. Lungs were clear to auscultation. Abdomen was soft, with no ...

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Beneficial effects of ACTH on the serum lipoprotein profile and glomerular function in patients with membranous nephropathy

Abstract: 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.

Cited by 98 publications

References 24 publications

ACTH reduces the rise in ApoB-48 levels after fat intake

ACTH reduces the rise in ApoB-48 levels after fat intake

Glomerular Diseases

Idiopathic Membranous Nephropathy

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