Adrenocorticotropic hormone (ACTH): A forgotten tool in the treatment of proteinuric nephropathies

Any new treatment option in proteinuric nephropathies is faced with several challenges namely doubtful efficacy, unfavourable side effects and prohibitive cost. In 1950s and 1960s, ACTH was widely used for the treatment of childhood nephrotic syndrome. With the availability of “better” therapeutic options, ACTH was dumped into oblivion. Recently there has been a renewed interest in ACTH. After the discovery of melanocortin receptors (MCRs), it is now known, these receptors are widely distributed in various organs including the kidneys. ACTH remains the preferred agonist of all the MCRs. Either through steroidogenesis, or other mechanism like immunomodulation, ACTH exerts its action in the kidneys to reduce proteinuria in proteinuric nephropathies. Both preclinical and clinical evidences are accumulating which speak in favour of a potential therapeutic role of ACTH in these disorders. ACTH might also be useful in inducing remission in steroid-resistant nephropathies, like immune-complex mediated glomerular diseases and podocytopathies. Large multicentre studies with ACTH are to be initiated, before a definite conclusion can be arrived at.