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

Berg, Anna-Lena LU ; Nilsson-Ehle, Peter LU and Arnadottir, M (1999) In Kidney International 56(4). p.1534-1543
Abstract
BACKGROUND: Previous studies have shown that short-term treatment with adrenocorticotrophic hormone (ACTH) has a strong and rapid lipid-lowering effect. In this long-term study of nephrotic patients with idiopathic membranous nephropathy, the influence of ACTH on the serum lipoprotein profile and glomerular function as well as the dose-effect relationship was investigated. METHODS: Fourteen patients received ACTH intramuscularly at increasing doses during 56 days. Serum concentrations of lipids, lipoproteins, and apolipoproteins as well as variables of glomerular function were analyzed, and the side-effects were recorded. ACTH treatment, in the estimated optimal dosage, was then continued in five patients with severe steroid-resistant... (More)
BACKGROUND: Previous studies have shown that short-term treatment with adrenocorticotrophic hormone (ACTH) has a strong and rapid lipid-lowering effect. In this long-term study of nephrotic patients with idiopathic membranous nephropathy, the influence of ACTH on the serum lipoprotein profile and glomerular function as well as the dose-effect relationship was investigated. METHODS: Fourteen patients received ACTH intramuscularly at increasing doses during 56 days. Serum concentrations of lipids, lipoproteins, and apolipoproteins as well as variables of glomerular function were analyzed, and the side-effects were recorded. ACTH treatment, in the estimated optimal dosage, was then continued in five patients with severe steroid-resistant nephrotic syndrome. In these five patients, the total treatment period was 12 months, and the follow-up time after discontinuing treatment was 18 months. RESULTS: Taking both the statistically significant therapeutic effects and the modest side-effects into consideration, the optimal dosage of ACTH was estimated to be 1 mg twice per week. At that dose, reductions by 30 to 60% in the serum concentrations of cholesterol, triglycerides, apolipoprotein B, and lipoprotein(a) were observed, whereas the serum concentrations of high-density lipoprotein cholesterol and apolipoprotein AI rose by 30 to 40%. In addition, the urinary albumin excretion decreased by 90%, and the glomerular filtration rate increased by 25%. Deterioration was observed in all cases when ACTH was discontinued after a treatment duration of 56 days. However, the five patients in whom ACTH therapy was resumed were still in remission 18 months after discontinuance of treatment. CONCLUSIONS: 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. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
adrenocorticotrophic hormone, glomerular filtration rate, lipoprotein(a), nephrotic syndrome, hyperlipoproteinemia
in
Kidney International
volume
56
issue
4
pages
1534 - 1543
publisher
Nature Publishing Group
external identifiers
  • pmid:10504505
  • scopus:0032843525
ISSN
1523-1755
DOI
10.1046/j.1523-1755.1999.00675.x
language
English
LU publication?
yes
id
4aacf45a-5f6f-4c38-ada5-ffe43ac8da4b (old id 1115790)
date added to LUP
2008-07-08 14:22:57
date last changed
2017-07-23 04:33:44
@article{4aacf45a-5f6f-4c38-ada5-ffe43ac8da4b,
  abstract     = {BACKGROUND: Previous studies have shown that short-term treatment with adrenocorticotrophic hormone (ACTH) has a strong and rapid lipid-lowering effect. In this long-term study of nephrotic patients with idiopathic membranous nephropathy, the influence of ACTH on the serum lipoprotein profile and glomerular function as well as the dose-effect relationship was investigated. METHODS: Fourteen patients received ACTH intramuscularly at increasing doses during 56 days. Serum concentrations of lipids, lipoproteins, and apolipoproteins as well as variables of glomerular function were analyzed, and the side-effects were recorded. ACTH treatment, in the estimated optimal dosage, was then continued in five patients with severe steroid-resistant nephrotic syndrome. In these five patients, the total treatment period was 12 months, and the follow-up time after discontinuing treatment was 18 months. RESULTS: Taking both the statistically significant therapeutic effects and the modest side-effects into consideration, the optimal dosage of ACTH was estimated to be 1 mg twice per week. At that dose, reductions by 30 to 60% in the serum concentrations of cholesterol, triglycerides, apolipoprotein B, and lipoprotein(a) were observed, whereas the serum concentrations of high-density lipoprotein cholesterol and apolipoprotein AI rose by 30 to 40%. In addition, the urinary albumin excretion decreased by 90%, and the glomerular filtration rate increased by 25%. Deterioration was observed in all cases when ACTH was discontinued after a treatment duration of 56 days. However, the five patients in whom ACTH therapy was resumed were still in remission 18 months after discontinuance of treatment. CONCLUSIONS: 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.},
  author       = {Berg, Anna-Lena and Nilsson-Ehle, Peter and Arnadottir, M},
  issn         = {1523-1755},
  keyword      = {adrenocorticotrophic hormone,glomerular filtration rate,lipoprotein(a),nephrotic syndrome,hyperlipoproteinemia},
  language     = {eng},
  number       = {4},
  pages        = {1534--1543},
  publisher    = {Nature Publishing Group},
  series       = {Kidney International},
  title        = {Beneficial effects of ACTH on the serum lipoprotein profile and glomerular function in patients with membranous nephropathy},
  url          = {http://dx.doi.org/10.1046/j.1523-1755.1999.00675.x},
  volume       = {56},
  year         = {1999},
}