Int J Gen Med. 2015 Mar 20;8:119-24. doi: 10.2147/IJGM.S79815. eCollection 2015.
Repository corticotropin injection in a patient presenting with focal segmental glomerulosclerosis, rheumatoid arthritis, and optic neuritis: a case report.
International journal of general medicine
Arvind Madan
Affiliations
Affiliations
- Nephrology Associates of Central Florida, PA, Orlando, FL, USA.
PMID: 25848316
PMCID: PMC4374712 DOI: 10.2147/IJGM.S79815
Abstract
BACKGROUND: Focal segmental glomerulosclerosis (FSGS) causes scarring or sclerosis of glomeruli that act as tiny filters in the kidneys, damage to which results in diminished ability to properly filter blood, resulting in the urinary loss of plasma proteins and subsequent proteinuria.
CASE PRESENTATION: A 60-year-old, white female with a history of intermittent proteinuria was referred by her primary care physician for renal dysfunction. Biopsy confirmed FSGS and she was treated with an angiotensin-converting enzyme inhibitor. She also had rheumatoid arthritis (RA) but no active synovitis and was maintained on prednisone 5 mg/d. She also complained of worsening vision in her right eye and was diagnosed with optic neuritis (ON). She remained stable for about 8 months when examination indicated FSGS relapse, and she reported painful RA flares. She was treated with Acthar(®) Gel (40 mg biweekly) for 6 months, after which proteinuria and urine protein-to-creatinine ratio decreased to about half. Her ON improved, and she reported that she had fewer RA flares and pain improved by 50%. This case of confirmed FSGS showed an improved response to treatment with Acthar Gel for FSGS with concomitant RA and ON.
CONCLUSION: This referral case is relevant to primary care practitioners who treat disorders that may be responsive to corticosteroid therapy. The antiproteinuric effects and ancillary improvement in RA and ON symptoms during treatment with Acthar Gel are not entirely explained by its steroidogenic actions. ACTH is a bioactive peptide that, together with α-melanocyte-stimulating hormone, exhibits biologic efficacy by modulating proinflammatory cytokines and subsequent leukocyte extravasation and may have autocrine/paracrine effects in joints. While Acthar Gel was primarily administered in this case to treat proteinuria, it also showed ancillary benefits in patients with concomitant inflammatory disease states.
Keywords: Acthar Gel; adrenocorticotropic hormone; nephrotic syndrome; proteinuria
References
- FASEB J. 2010 Dec;24(12):4835-43 - PubMed
- Curr Opin Rheumatol. 2013 May;25(3):375-83 - PubMed
- N Engl J Med. 2006 Mar 23;354(12):1273-80 - PubMed
- J Neurol. 2000 Jun;247(6):435-42 - PubMed
- Pharmacol Ther. 2006 Jul;111(1):1-15 - PubMed
- J Am Soc Nephrol. 2010 Aug;21(8):1290-8 - PubMed
- N Engl J Med. 2009 Jan 1;360(1):44-52 - PubMed
- Arthritis Rheum. 2010 Sep;62(9):2569-81 - PubMed
- Pharmacogenomics. 2013 Mar;14(4):425-44 - PubMed
- Kidney Int. 2008 Feb;73(4):399-406 - PubMed
- Pharmacol Rev. 2004 Mar;56(1):1-29 - PubMed
- Drug Des Devel Ther. 2011 Mar 14;5:147-53 - PubMed
- Adv Chronic Kidney Dis. 2014 Mar;21(2):134-51 - PubMed
- Curr Opin Nephrol Hypertens. 2007 Jan;16(1):32-8 - PubMed
- Am J Nephrol. 2012;36(1):58-67 - PubMed
- Med Health R I. 2008 Feb;91(2):57-9 - PubMed
- Clin J Am Soc Nephrol. 2013 Dec;8(12):2072-81 - PubMed
- Control Clin Trials. 1991 Aug;12(4):486-503 - PubMed
- ScientificWorldJournal. 2009 Dec 16;9:1394-414 - PubMed
- Nat Rev Nephrol. 2011 Dec 06;8(2):122-8 - PubMed
Publication Types