Corticosteroids (cortisone treatment)

Cortisol is a vital stress hormone that is stimulated by stressors such as infections, injuries and mental stress reactions. The adrenal glands produce cortisol while the brain controls the amount of cortisol through production of ACTH in the pituitary gland. Cortisol affects all the cells of the body. It has a catabolic effect through metabolising stored energy and increasing gluconeogenesis. Cortisol, in high amounts, will also lead to salt and water retention by stimulating the aldosterone receptor on the principal cells in the collecting duct. (Link to principal cells). Salt and water retention will increase the circulating blood volume and improve tissue perfusion during a stress reaction. The most important effects of cortisol that we take advantage of are its ability to modulate the immune response, suppress the immune system, and inhibit the cytokine response and the cytotoxic effects of white blood cells. Corticosteroids are an important component in the treatment of many autoimmune kidney-related diseases where the body's own immune system attacks its own tissue or where the immune response overreacts. The side effects of long term use are severe, which is why the lowest effective dosage possible should be sought. Hypertension, development of diabetes mellitus and a cushing-like appearance with slender extremities and central obesity, fragile skin, and osteoporosis are all normal side effects that will characterise a patient that is treated with corticosteroids over time.