ACTH (corticotrophin) therapy in resistant primary membranous nephropathy

Primary membranous nephropathy is a common cause of nephrotic syndrome in adults. Failure to achieve remission of proteinuria is a risk factor for progression to end-stage renal disease. 1 Couser W.G. Primary membranous nephropathy. Clin J Am Soc Nephrol. 2017; 12: 983-997 Crossref PubMed Scopus (288) Google Scholar Cyclophosphamide with steroids, calcineurin inhibitors, and rituximab have been used for treating primary membranous nephropathy with response rates varying from 50% to 70%. 1 Couser W.G. Primary membranous nephropathy. Clin J Am Soc Nephrol. 2017; 12: 983-997 Crossref PubMed Scopus (288) Google Scholar It is difficult to predict response, and some patients who do not improve with one immmunosuppressive regimen may respond to another therapy.