Which intramuscular drug was given daily in the 1960s to children with nephrotic syndrome?

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Historical Intramuscular Treatment for Childhood Nephrotic Syndrome in the 1960s

Adrenocorticotropic hormone (ACTH) was the intramuscular drug given daily in the 1960s for childhood nephrotic syndrome, before being replaced by oral glucocorticoids (prednisone/prednisolone). 1, 2, 3, 4

Historical Context and Treatment Evolution

ACTH was widely used throughout the 1950s and 1960s as the primary treatment for childhood nephrotic syndrome, administered via intramuscular injection. 3, 4 This therapy dramatically altered nephrotic syndrome management during that era, initially through recognition of its diuresis effects and subsequently through sustained proteinuria remission. 3

Why ACTH Was Used

  • Before ACTH availability in the late 1940s, children with nephrotic syndrome suffered severe edema and high mortality rates with no reliable or safe treatment options. 3
  • ACTH demonstrated remarkable efficacy in early clinical studies, with initial diuresis response occurring in 74% of patients across short-term treatment courses (≤28 days). 3
  • Proteinuria response was achieved in 56% of patients during short-term ACTH therapy and improved to 71% with long-term intermittent treatment protocols. 3
  • Sustained remission was documented for up to 4.7 years following ACTH treatment in early clinical studies. 3

The Transition to Oral Corticosteroids

  • By the 1960s and 1970s, the International Study of Kidney Disease in Children established oral corticosteroid regimens (60 mg/m²/day for 3 consecutive weeks followed by 4 weeks of alternate-day dosing) as the new standard treatment. 1
  • ACTH became less popular with the advent of oral glucocorticoids (prednisone/prednisolone), which offered easier administration and comparable efficacy. 2, 4
  • The shift from intramuscular ACTH to oral steroids represented a major advancement in convenience and patient acceptability, though ACTH had proven highly effective. 4

Contemporary Relevance

  • ACTH has re-emerged in recent decades as a treatment option for refractory nephrotic syndrome in patients who fail conventional immunosuppressive therapies. 2, 5, 4
  • Modern applications focus on treatment-resistant cases, particularly in adults with membranous nephropathy and other proteinuric nephropathies resistant to steroids and immunosuppressants. 5, 4
  • The mechanism extends beyond steroidogenesis, as ACTH acts as an important physiological agonist of the melanocortin system with antiproteinuric, lipid-lowering, and renoprotective properties. 4

References

1
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Dr.Oracle Medical Advisory Board & Editors, 2025

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