Experience With Acth In Membranous Nephropathy In Older Patients

Abstract

Background The most common cause of nephrotic syndrome in the older population is probably memranous nephropathy (MN). Treatment of patients with nephrotic syndrome caused by MN with adrenocorticotrophic hormon (ACTH) is shown to be efficient as primary and secondary therapy. We present our experience using ACTH in older patients with MN.Methods Between 2016 and 2019 six older patients with MN were treated with ACTH gel. We have used tetracosactide, a synthetic analog of ACTH, in intramuscular doses of 1 mg twice a week for 6-9 months. Estimated glomerular filtration rate, levels of albumin, glucose and proteinuria were studied both before and monthly during the follow-up period. Response in proteinuria was assessed as percent reduction from baseline level and as percent of patients with complete or partial remission or no response. Safety and tolerability were evaluated using the reported adverse event frequency either by the patients or the treating nephrologist and using the frequency of discontinuation due to adverse events.Results Three patients achieved total and another two partial remission with ACTH therapy for 6 months. One of the patients did not meet partial remission criteria but had a decrease in proteinuria level. None of the patients experienced cardiovascular or infectious events or a decrease in renal function.Conclusions ACTH is a good therapeutic alternative in older patients with MN with preserved renal function. Further controlled studies are needed to clarify the benefits of ACTH as a first line treatment option in older patients with MN and compare its use with other currently available therapies.