在 IgA 肾病患者中使用合成促肾上腺皮质激素。
Use of synthetic adrenocorticotropic hormone in patients with IgA nephropathy.
机构信息
Section of Nephrology, Department of Medicine, Regina General Hospital, 1440, 14th Avenue, Regina, SK, S4P 0W5, Canada.
Faculty of Nursing, Research and Innovation Centre, University of Regina, Room 508, 3737, Wascana Parkway, Regina, SK, S4S 0A2, Canada.
出版信息
BMC Nephrol. 2018 May 23;19(1):118. doi: 10.1186/s12882-018-0915-4.
BACKGROUND
Synthetic adrenocorticotropic hormone (ACTH) has been demonstrated to be effective in patients with membranous nephropathy, minimal change disease and some histological subtypes of focal segmental glomerulosclerosis. Its clinical impact in patients with IgA nephropathy is currently unclear.
CASE PRESENTATION
In this report, we describe the clinical use of ACTH in patients with IgA nephropathy. Three female patients (24-44 years) with overt proteinuria received intramuscular (IM) ACTH for varying time periods (8-14 months). Pre-treatment urine protein varied from 2.9 g/d to 4.3 g/d.
CONCLUSIONS
There was complete remission in one patient on ACTH monotherapy and in the other two when prescribed as a steroid-sparing agent in combination with cyclophosphamide. All three had resolution in proteinuria to less than 1 g/d and maintained their GFR to baseline values. There were no reported side effects at a once a week dose. This study illustrates that ACTH is an effective agent that is well tolerated with minimal side effects and can be used as an alternative to prednisone in patients with IgA nephropathy.
背景
合成促肾上腺皮质激素（ACTH）已被证明对膜性肾病、微小病变病和局灶节段性肾小球硬化的某些组织学亚型患者有效。其在 IgA 肾病患者中的临床影响目前尚不清楚。
病例介绍
本报告描述了 ACTH 在 IgA 肾病患者中的临床应用。三名女性患者（24-44 岁）出现显性蛋白尿，接受了肌内（IM）ACTH 治疗，治疗时间长短不一（8-14 个月）。治疗前尿蛋白量从 2.9g/d 到 4.3g/d 不等。
结论
ACTH 单药治疗使一名患者完全缓解，与环磷酰胺联合作为类固醇保留剂治疗使另外两名患者缓解。所有患者的蛋白尿均降至 1g/d 以下，肾小球滤过率（GFR）维持在基线值。每周一次剂量时无不良反应报告。本研究表明，ACTH 是一种有效且耐受性良好的药物，可作为 IgA 肾病患者泼尼松的替代药物。
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