Significance of tonsillectomy combined with steroid pulse therapy for IgA nephropathy with mild proteinuria

Komatsu, Hiroyuki; Sato, Yuji; Miyamoto, Tetsu; Tamura, Masahito; Nakata, Takeshi; Tomo, Tadashi; Nishino, Tomoya; Miyazaki, Masanobu; Fujimoto, Shouichi
February 2016
Clinical & Experimental Nephrology;Feb2016, Vol. 20 Issue 1, p94
Academic Journal
Background: Medical intervention for patients with IgA nephropathy and mild proteinuria (<1.0 g/day) is controversial, and the effectiveness of tonsillectomy plus steroid pulse therapy (TSP) for such patients remains obscure. Methods: Among 323 patients in our multicenter cohort study, 79 who had mild proteinuria (0.4-1.0 g/day) at diagnosis were eligible to participate in this study. We compared the clinicopathological findings at diagnosis, a decline in renal function defined as a 50 or 100 % increase in serum creatinine (sCr) and clinical remission (CR) defined as the disappearance of hematuria and proteinuria (<0.3 g/day) among groups given TSP ( n = 46), steroid therapy (ST) ( n = 9), and non-ST ( n = 24). Factors contributing to CR were also evaluated using multivariate analysis. Results: Background factors at diagnosis including age, ratio (%) of patients with hypertension, sCr, proteinuria, and histological severity did not significantly differ among the groups. Only two patients each in the TSP (4.3 %) and non-ST (8.3 %) groups achieved a 50 % increase in sCr during a mean follow-up period of 4.7 years. At the final observation, 71.7, 44.4, and 41.7 % of patients in the TSP, ST, and non-ST groups, respectively, achieved CR ( p = 0.032). Cox proportional hazards models revealed that TSP led to CR more effectively than non-TSP by a factor of about threefold (hazard ratio, 2.74; p = 0.008). Conclusion: TSP therapy has potential for inducing CR in patients with IgAN and mild proteinuria (<1.0 g/day).


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