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2017 ; 30
(1
): 35-44
Nephropedia Template TP
gab.com Text
Twit Text FOAVip
Twit Text #
English Wikipedia
Adrenocorticotropic hormone therapy for the treatment of idiopathic nephrotic
syndrome in children and young adults: a systematic review of early clinical
studies with contemporary relevance
#MMPMID27084801
Lieberman KV
; Pavlova-Wolf A
J Nephrol
2017[Feb]; 30
(1
): 35-44
PMID27084801
show ga
Adrenocorticotropic hormone (ACTH) as a treatment for proteinuria due to
nephrotic syndrome (NS) has re-emerged over the last decade. Current clinical
data are primarily limited to adults with treatment-resistant NS. Largely unknown
to today's clinicians is the existence of early clinical studies, following
ACTH's introduction in the late 1940s, showing sustained proteinuria response in
idiopathic NS in predominantly pediatric, treatment-naïve patients. Before ACTH,
patients suffered severe edema and high mortality rates with no reliable or safe
treatment. ACTH dramatically altered NS management, initially through recognition
of diuresis effects and then through sustained proteinuria remission. This review
synthesizes early clinical literature to inform current NS patient management. We
undertook a MEDLINE search using MeSH terms "adrenocorticotropic hormone" and
"nephrotic syndrome," with limits 1945-1965 and English. Sixty papers totaling
1137 patients were found; 14 studies (9 short-term, five long-term, N = 419
patients) met inclusion criteria. Studies were divided into two groups:
short-term (?28 days) and long-term (>5 weeks; short-term initial daily treatment
followed by long-term intermittent)ACTH therapy and results were aggregated. An
initial response, defined as a diuresis, occurred in 74 % of patients/treatment
courses across nine short-term ACTH studies. Analyzed in eight of these studies,
proteinuria response occurred in 56 % of patients/treatment courses. Across five
long-term ACTH studies, proteinuria response was shown in 71 % of patients and
was sustained up to 4.7 years following treatment. The inventory and
re-evaluation of early clinical data broadens the evidence base of clinical
experiences with ACTH for implementation of current treatment strategies and
aiding the design of future studies.
|Adolescent
[MESH]
|Adrenocorticotropic Hormone/adverse effects/*therapeutic use
[MESH]