Table 7.

Potential future considerations of ACTH in glomerular diseases

Glomerular disease	Indication	Treatment regimen
MN	As first-line therapy or in resistant MN	ACTH alone or in a combination with other immunosuppressive therapies. Response may depend on cumulative dose of ACTH [13]
		Suggested dose: – Natural ACTH 80 IU twice weekly for at least 3 months [13] – Synthetic ACTH (tetracosactide or Synacthen depot) 1 mg twice weekly for at least 3 months [11]
FSGS and MCD	Resistant FSGS or MCD (data are limited)	ACTH alone or in a combination with another immunosuppressive therapy Suggested dose: – Natural ACTH (Acthar) 80 IU twice weekly for at least 6 months [5, 6] – Synthetic ACTH (tetracosactide or Synacthen depot) 0.5–1 mg twice weekly for at least 6 months [7, 27]
IgA nephropathy	Proteinuria >1 g/day despite maximally tolerated RAAS blockade (data are limited)	Suggested dose: – Natural ACTH (Acthar) 80 IU twice weekly for at least 6 months [5]

ACTH, adrenocorticotropic hormone; FSGS, focal segmental glomerulosclerosis; MCD, minimal change disease; MN, membranous nephropathy; RAAS, renin–angiotensin–aldosterone system.

Data are lacking to make any recommendations for lupus nephritis, MN and diabetic nephropathy.