Prolonged Intermittent Acth and Cortisone Therapy in the Nephrotic Syndrome; Immunologic Basis and Results

Abstract

1) Serum complement levels were always low in 40 cases with acute and subacute glomerulonephritis. 2) Serum complement levels were low in 27 of 29 cases with the nephrotic syndrome whether or not underlying glomerulonephritis could be demonstrated. 3) The low complement levels were not due to loss of complement into the urine, lack of formation or anticomplementary factors. 4) Spontaneous remissions of the nephrotic syndrome were preceded in 11 of 13 instances by high fever. Depression of the eosinophil count (4 patients) and a rise in urinary 17-ketosteroids (1 patient) were observed. 5) Complement rose prior to the diuresis in spontaneous remissions, and fell prior to relapses. 6) Rise in serum complement and diuresis occurred independent of changes in plasma protein levels and changes in plasma oncotic pressure. 7) In the nephrotic syndrome large doses of ACTH and oral cortisone led to a rise in complement levels followed by diuresis. Relapses were preceded by a fall in complement. 8) ACTH given for 3 to 8 weeks on 3 successive days of each week after an initial 7 to 10 day course of ACTH was accompanied by long-lasting remissions in 3 out of 6 patients. 9) Oral cortisone given in high doses in a similar schedule after an initial 7 to 10 day course of ACTH was accompanied by long remissions in 16 out of 18 patients when given for 6 to 30 courses. 10) Cortisone maintenance therapy led to a rapid return to normal in the levels of plasma protein and cholesterol and a reduction of proteinuria. 11) Cortisone maintenance therapy did not produce diuresis in 4 patients but prevented relapses in a high percentage of patients. 12) There was no fatality in 29 patients with the nephrotic syndrome observed for from 3 to 40 months during or after maintenance therapy.