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Kidney Week

Abstract: PO2216

Repository Corticotropin (Acthar®) in Treating De Novo C3 Glomerulonephritis Post Transplantation

Session Information

Category: Transplantation

  • 1902 Transplantation: Clinical

Authors

  • Naseer, Muhammad Saad, Willis Knighton Medical Center, Shreveport, Louisiana, United States
  • Singh, Ayush, Willis Knighton Medical Center, Shreveport, Louisiana, United States
  • Singh, Neeraj, Willis Knighton Medical Center, Shreveport, Louisiana, United States
Introduction

De-novo C3 glomerulonephritis (C3GN) post-transplant is uncommon. Although eculizumab has been used successfully in several cases, the response is heterogeneous and treatment strategies remain undefined. The use of repository corticotropin in C3GN has not been described in the literature.

Case Description

A 48-year-old African American male with kidney transplantation secondary to diabetic nephropathy presented 6 years post-transplant with lower extremity edema and nephrotic range proteinuria of 8.2 g/g of creatinine. His renal allograft biopsy confirmed the diagnosis of C3GN (Figure 1). He was treated with eculizumab (Solaris®) 900 mg IV once weekly for 4 weeks and repository corticotropin (H.P. Acthar® gel) 80 units subcutaneous twice weekly for 6 months with complete resolution of proteinuria within 3 months of the treatment. However, the patient presented again after 6 months of completing therapy with a recurrence of proteinuria which peaked at 11.6 g/g of creatinine. The kidney allograft biopsy was consistent with C3GN. He was started on Acthar® 80 units subcutaneous twice weekly and the proteinuria was reduced to >50% within 2 months of therapy. When eculizumab 900 mg IV once weekly for 4 weeks was added with Acthar®, the proteinuria fully resolved within 10 weeks of treatment. Since then, the patient has been maintained on Acthar® monotherapy of 40 units subcutaneous twice weekly and has stayed in complete remission of proteinuria for more than a year till his last follow-up.

Discussion

In conclusion, this is the first case report describing the role of repository corticotropin as an effective therapy in reducing proteinuria and maintaining patients with C3GN in complete remission.

Figure 1. Kidney Allograft Biopsy
A & B: PAS shows a membranoproliferative pattern
C: EM shows large subendothelial deposits (red arrow)
D: IF shows a strong C3 reaction of mesangial and capillary walls