ACTH-induced improvement in the nephrotic syndrome in patients with a variety of diagnoses.

In the fifties and the sixties, ACTH was widely used for the treatment of childhood nephrosis probably caused by minimal change disease in most cases [1,2]. This treatment was provided in lieu of steroids since it does not suppress the adrenal glands and there were hopes of less growth stunting. There are a few reported cases of ACTH treatment in nephrotic patients who had not been biopsied but probably suffered from other diseases than minimal change disease [3,4]. These patients received huge doses of short-acting ACTH for days or weeks and some of then seemed to respond, at least partially. During the last few decades the use of ACTH has been limited due to the fact that the preparation must be given parenterally. We have reported that treatment with a synthetic ACTH analogue (ACTH1–24; Synacthen Depot) was associated with reduced albuminuria in patients with idiopathic membranous nephropathy [5]. This was incidentally noted during a treatment trial in nephrotic patients with idiopathic membranous nephropathy which focused on the lipid-lowering effects of ACTH [5]. The marked reduction in albuminuria observed in all the study participants suggested that this effect was not coincidental. During the time interval between the above study and an ongoing controlled trial, we continued to administer ACTH to nephrotic patients who were not expected to respond to steroids. Roughly half of the patients suffered from idiopathic membranous nephropathy but the rest had different diagnoses. We now report these cases. Cases