Use of Repository Corticotropin Gel (Acthar) in Progressive Nephrotic Syndrome Secondary to Transplant Glomerulopathy: A Report of Three Cases

Markell, Mariana S.; Brar, Amarpali; Bhela, Serena; Patel, Ankita; Salifu, Moro

doi:10.1016/j.xkme.2018.12.003

Cited by 4 publications

(5 citation statements)

References 22 publications

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“…In an analysis of 14 patients with recurrent FSGS from 2 transplant centers, patients received ACTH therapy for 6 months to 2 years with an overall response rate of 36% without adverse events 20 . Besides, previous studies have indicated that ACTH has a certain effect on the recurrent FSGS resistant to conventional therapy 2,3,6,21–23 . The urinary protein of this patient in our center decreased significantly after 1 year of ACTH treatment and was maintained at 0.6~1.1 g/m 2 /day.…”

Section: Discussionmentioning

confidence: 69%

“…20 Besides, previous studies have indicated that ACTH has a certain effect on the recurrent FSGS resistant to conventional therapy. 2,3,6,[21][22][23] The urinary protein of this patient in our center decreased significantly after 1 year of ACTH treatment and was maintained at 0.6~1.1 g/m 2 /day. After 568 days of ACTH treatment, the urinary protein decreased below 0.5 g/m 2 /day and was maintained until now.…”

Section: F I G U R E 3 Renal Function After Using Acthmentioning

confidence: 64%

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Application of adrenocorticotropic hormone in recurrent focal segmental glomerulosclerosis post‐transplantation: A case report and literature review

Chen

Ying

et al. 2021

Pediatric Transplantation

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Background The recurrence rate of focal segmental glomerulosclerosis (FSGS) post‐renal transplantation is as high as 30%–50%. However, the pathogenesis is unclear. At present, there is no unified standard for the treatment of recurrent FSGS post‐transplantation. Its treatment is full of risks and challenges. Methods We report a child with recurrent FSGS with massive proteinuria 6~9 g/m2/day and resistance to plasma exchange (PE) and rituximab (RTX). On the basis of receiving anti‐rejection therapy of prednisone, tacrolimus, and mycophenolate mofetil (MMF), we treated the child with adrenocorticotropic hormone (ACTH), and reviewed the literature on the application of ACTH in the recurrence of FSGS post‐transplantation. Results After 1 year of treatment with ACTH, the patient's urinary protein decreased and fluctuated between 0.6 and 1.1 g/m2/day. The albumin (ALB) and cholesterol (CHOL) returned to the normal range. The patient achieved complete remission after 19 months of ACTH treatment and maintained until now. There was no obvious adverse reaction. Literature review showed that up to February 2021, a total of 8 studies showed the use of ACTH in kidney transplant patients, and all the patients in the study achieved remission. Conclusions ACTH is a potential option for treating recurrent FSGS post‐transplantation with fewer side effects and relatively safe for patients. However, further evaluation is needed to better adapt to different populations.

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Section: Discussionmentioning

confidence: 69%

Section: F I G U R E 3 Renal Function After Using Acthmentioning

confidence: 64%

Application of adrenocorticotropic hormone in recurrent focal segmental glomerulosclerosis post‐transplantation: A case report and literature review

Chen

Ying

et al. 2021

Pediatric Transplantation

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“…However, responses are wide, and further research is needed to identify those patients who are benefitted by rituximab treatment and those who are non-effective. A clinical study showed that adrenocorticotropic hormone exerted its role through activated melanocortin receptors (MC1R–MC5R) that existed in the whole body were effective therapy for IMN patients who failed immunosuppressive treatment ( Markell et al, 2019 ; Wu et al, 2021b ). Melanocortin one receptor occurred in B cells, T cells, podocytes, and antigen-presenting cells.…”

Section: Treatment Of Membranous Nephropathymentioning

confidence: 99%

Recent Advances in Clinical Diagnosis and Pharmacotherapy Options of Membranous Nephropathy

et al. 2022

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Membranous nephropathy (MN) is the most common cause of nephrotic syndrome among adults, which is the leading glomerular disease that recurs after kidney transplantation. Treatment for MN remained controversial and challenging, partly owing to absence of sensitive and specific biomarkers and effective therapy for prediction and diagnosis of disease activity. MN starts with the formation and deposition of circulating immune complexes on the outer area in the glomerular basement membrane, leading to complement activation. The identification of autoantibodies against the phospholipase A2 receptor (PLA2R) and thrombospondin type-1 domain-containing protein 7A (THSD7A) antigens illuminated a distinct pathophysiological rationale for MN treatments. Nowadays, detection of serum anti-PLA2R antibodies and deposited glomerular PLA2R antigen can be routinely applied to MN. Anti-PLA2R antibodies exhibited much high specificity and sensitivity. Measurement of PLA2R in immune complex deposition allows for the diagnosis of PLA2R-associated MN in patients with renal biopsies. In the review, we critically summarized newer diagnosis biomarkers including PLA2R and THSD7A tests and novel promising therapies by using traditional Chinese medicines such as Astragalus membranaceus, Tripterygium wilfordii, and Astragaloside IV for the treatment of MN patients. We also described unresolved questions and future challenges to reveal the diagnosis and treatments of MN. These unprecedented breakthroughs were quickly translated to clinical diagnosis and management. Considerable advances of detection methods played a critical role in diagnosis and monitoring of treatment.

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“…A single center report described the potential benefit of Acthar gel in TG 63 . Further controlled trials are required to test its use in TG.…”

Section: Treatmentmentioning

confidence: 99%

Chronic transplant glomerulopathy: New insights into pathogenesis

Gokhale

Chancay

Shapiro

et al. 2021

Clinical Transplantation

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There have been recent significant advances in short‐term outcomes in renal transplantation, however, long‐term allograft survival remains a challenge. With reported incidences as high of 74.5% of chronic graft loss in patients with biopsies showing transplant glomerulopathy (TG), this syndrome represents an important factor for chronic allograft complications. In this review we show an overview of the novel mechanistic insights into pathogenesis of TG, as well as a brief description of the pathology, diagnosis and newer prognostic indices within TG diagnosis. These data raise intriguing roles for cell‐mediated immunity and podocyte stress in TG as well as reinforce previous associations of TG with ABMR. We also delve into management strategies for TG and report the paucity of existing clinical trial data for this prevalent condition in renal transplants.

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Use of Repository Corticotropin Gel (Acthar) in Progressive Nephrotic Syndrome Secondary to Transplant Glomerulopathy: A Report of Three Cases

Cited by 4 publications

References 22 publications

Application of adrenocorticotropic hormone in recurrent focal segmental glomerulosclerosis post‐transplantation: A case report and literature review

Application of adrenocorticotropic hormone in recurrent focal segmental glomerulosclerosis post‐transplantation: A case report and literature review

Recent Advances in Clinical Diagnosis and Pharmacotherapy Options of Membranous Nephropathy

Chronic transplant glomerulopathy: New insights into pathogenesis

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