The purpose of this study is to determine whether treatment with long-acting synthetic adrenocorticotropic hormone is in the treatment of patients with idiopathic membranous nephropathy and high for renal failure.

Inclusion Criteria:

• Biopsy-proven idiopathic membranous nephropathy.

• Nephrotic syndrome: proteinuria > 3.5 g/day and serum albumine < 30 g/l

• Normal or mildly impaired renal function (eGFR > 60 ml/min, MDRD formula)

• High risk for renal failure: beta-2-microglobulin excretion > 500 ng/min

• Relative contra-indication for cyclophosphamide treatment:

  • fertility and wish for (future) family expanding
  • high age ( > 60 years)
  • former cyclophosphamide treatment
  • intolerance to cyclophosphamide

Exclusion Criteria:

• Clinical,biochemical or histological signs of any underlying systemic disease
• Any infectious disease (including latent tuberculosis and/or latent amoebiasis)
• Active gastric or duodenal ulcers
• Pregnancy, lactation, inadequate contraceptives
• Clinical signs of renal vein thrombosis
• Asthma and /or any allergic conditions or hypersensitivity reactions
• Allergic reaction to synthetic ACTH in the past