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Article Review/Hyperlink
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Birmingham DJ, Shen XP, Hartman JA, Dillon JJ, Hebert LA
ACTH lowers serum lipids in steroid-treated hyperlipemic
patients with kidney disease
Kidney Int
(Aug) 50:538-542 1996

Hyperlipidemias are common in patients with nephrotic syndrome,
progressive forms of chronic renal failure, dialysis and renal
transplantation. Moreover, hyperlipidemia may play an important role
in the pathogenesis of atherosclerosis and development of
life-threatening cardiovascular diseases in these patient populations.
The mechanisms of hyperlipidemia in these situations are complex and
incompletely understood. In addition, corticosteroids (and other
immunosuppressives) can cause hyperlipidemia. How steroids induce
hyperlipidemia is the subject of intense investigation and debate.
Moreover, it appears that multiple factors are probably involved.
Increased hepatic VLDL production owing to increased insulin levels,
increased dietary intake of calories and fat as a result of appetite
stimulation and impaired clearance of apoB containing lipoproteins
have all been suggested as explanatory factors. This study tested a
new hypothesis, namely that ACTH deficiency in steroid-treated renal
transplant patients and patients with chronic glomerulonephritides
causes dyslipidemia. Plasma ACTH levels were at the lower limit of
normal in patients prior to ACTH administration. After ACTH (1 mg
subcutaneously on 8 days) over a 17 day period, the authors found
that plasma concentrations of total cholesterol, LDL cholesterol,
total triglycerides and total apoB decreased by 30-40% in both groups
of patients. In addition, HDL cholesterol and lipoprotein lipase
activity, but not hepatic lipase activity were significantly
increased. Although plasma ACTH concentrations did not change both
plasma and urinary cortisol levels increased markedly in response to
ACTH. The fact that ACTH administration increased lipoprotein lipase
activity may in part explain the lowering of plasma triglyceride. Yet
other mechanisms may also be operative. In vitro evidence suggests
that ACTH can directly stimulate uptake of apoB containing
lipoproteins in Hep G2 cells. Whatever the mechanism, this study may
have important therapeutic implications in the future.
Comment: If long-term treatment with ACTH or analogs is
safe and effective for lowering elevated LDL-cholesterol and
triglycerides in patients with renal disease, it could be important in
affecting patient outcome. (Robert D. Toto, M.D., University of
Texas Southwestern Medical Center)
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