Adrenocorticotropic hormone: Therapeutic use and effects in nephrotic syndrome

Gul-E-Zernab 1, Nitesh Mutyala 2, Shivkumar Vikasbhai Patel 3, Raef Nizar Ali 4, Sri lakshmi Sai Monica Chilla 5, Manal Upadhyay 6, Srijamya 7, * and Munawar Izhar 8

1 Department of Medicine, Mohtarma Benazir Bhutto Shaheed Medical College, Mirpur, Pakistan.
2 Department of Medicine, Andhra Medical College, Visakhapatnam, India.
3 Department of Medicine, Smt. B. K. Shah Medical Institute and Research Centre, Gujarat, India.
4 Department of Medicine, Mu’tah University, Amman, Jordan.
5 Department of Medicine, Dr NTR University of Medical sciences, Eluru, India.
6 Department of Medicine, GMERS Medical college and hospital, Gotri, Gujarat, India.
7 Department of Medicine, Ivane Javakhishvili Tbilisi State University, Tbilisi, Georgia.
8 Department of Nephrology, Chicago Hospitals and Collaborative Research Institute, Chicago, Illinois, USA.
 
Review
International Journal of Science and Research Archive, 2024, 13(01), 334–339.
Article DOI: 10.30574/ijsra.2024.13.1.1642
Publication history: 
Received on 26 July 2024; revised on 05 September 2024; accepted on 08 September 2024
 
Abstract: 
Background: NS is defined by the presence of significant proteinuria, which leads to low levels of albumin in the blood and the development of edema. This occurs as a result of damage to the glomerular filtration barrier. Corticosteroids are the main therapeutic approach for NS. Prolonged usage of steroids can result in numerous side effects, including steroid resistant NS, which poses a difficult challenge for treatment and can cause substantial morbidity and mortality. Although efforts have been made to decrease the use of steroids by employing non-steroidal immunosuppressive drugs for rapid recovery, these treatments have also exhibited adverse consequences. These difficulties have prompted the notion of utilizing ACTH in these situations.
Objective: This study seeks to analyze the efficacy of ACTH by thoroughly examining its mechanism and comparing it to conventional treatment for NS.
Summary and important messages: The study demonstrates that ACTH has the potential to not only decrease protein loss but also reduce the occurrence of relapses and the amount of glucosteroids required. This suggests that ACTH could be a viable treatment alternative. The exact mechanism is currently unidentified, while the MCR1 agonism linked to ACTH suggest a renoprotective mechanism that is beneficial in NS. A comprehensive analysis using a large-scale randomized controlled trial is necessary to fully comprehend the effectiveness and safety profile of ACTH in improving the quality of care for patients.
 
Keywords: 
ACTH; Nephrotic syndrome; Nephrology; Proteinuria; Glucocorticosteroids
 
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