New diagnostic tests and new therapies for glomerular diseases.

There has recently been considerable progress in our understanding of the pathology and mechanisms of a number of primary glomerulopathies. However, without parallel advancement in both our diagnostic skills and treatment methods, such advances cannot be translated into clinical progress. Fortunately, a number of new promising diagnostic tests are being evaluated in patients with a variety of primary glomerulopathies including focal segmental glomerulosclerosis membranous nephropathy, IgA nephropathy, and C3 glomerulopathies.

Treatment of nephrotic syndrome with adrenocorticotropic hormone (ACTH) gel.

Purpose: A synthetic adrenocorticotropin (ACTH) analog has shown efficacy in Europe as primary and secondary therapy for nephrotic syndrome, but there is no published experience using the natural, highly purified ACTH gel formulation, available in the United States, for nephrotic syndrome. We therefore investigated the use of ACTH gel for nephrotic syndrome in the United States.

Patients And Methods: Twenty-one patients with nephrotic syndrome treated with ACTH gel outside of research settings in the United States, with initiation of therapy by December 31, 2009, allowing a minimum 6 months follow-up.

An update on the use of mycophenolate mofetil in lupus nephritis and other primary glomerular diseases.

Mycophenolate mofetil (MMF) has been used successfully as an immunosuppressive medication in transplantation for over a decade. Owing to its efficacy and relatively benign adverse effect profile, its use has been investigated in the treatment of several glomerular diseases, as we describe in this Review. Of these, MMF has most extensively been studied in lupus nephritis.