Abstract | BACKGROUND: METHODS: We conducted a single-center 7-year historical cohort study in 200 patients with biopsy-proven IgA nephropathy. Study outcomes were clinical remission defined as disappearance of urine abnormalities at two consecutive visits, glomerular filtration rate (GFR) decline defined as 30% GFR decrease from baseline and GFR slope during the follow-up. RESULTS: Seventy of the 200 patients received tonsillectomy. Tonsillectomy was associated with increased incidence of clinical remission (P+0.01, log-rank test) and decreased incidence of GFR decline (P=0.01, log-rank test). After adjustment for age and gender, hazard ratios in tonsillectomy were 3.90 (95% confidence interval 2.46-6.18) for clinical remission and 0.14 (0.02-1.03) for GFR decline. After further adjustment for laboratory (baseline mean arterial pressure, GFR, 24-h proteinuria and hematuria score), histological (mesangial score, segmental sclerosis or adhesion, endocapillary proliferation and interstitial fibrosis) or treatment variables ( steroid and renin-angiotensin system inhibitors), similar results were obtained in each model. Even after exclusion of 69 steroid-treated patients, results did not change. GFR slopes in tonsillectomy and non- tonsillectomy groups were 0.60±3.65 and -1.64±2.59 mL/min/1.73 m2/year, respectively. In the multiple regression model, tonsillectomy prevented GFR decline during the follow-up period (regression coefficient 2.00, P=0.01). CONCLUSION:
Tonsillectomy was associated with a favorable renal outcome of IgA nephropathy in terms of clinical remission and delayed renal deterioration even in non- steroid-treated patients.
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Authors | Isseki Maeda, Tomoshige Hayashi, Kyoko Kogawa Sato, Mikiko Okumoto Shibata, Masahiro Hamada, Masatsugu Kishida, Chizuko Kitabayashi, Takashi Morikawa, Noriyuki Okada, Michiaki Okumura, Masayo Konishi, Yoshio Konishi, Ginji Endo, Masahito Imanishi |
Journal | Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association
(Nephrol Dial Transplant)
Vol. 27
Issue 7
Pg. 2806-13
(Jul 2012)
ISSN: 1460-2385 [Electronic] England |
PMID | 22492824
(Publication Type: Clinical Trial, Comparative Study, Journal Article)
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Chemical References |
- Anti-Inflammatory Agents
- Prednisolone
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Topics |
- Adult
- Anti-Inflammatory Agents
(therapeutic use)
- Arterial Pressure
- Cohort Studies
- Disease Progression
- Female
- Follow-Up Studies
- Glomerular Filtration Rate
- Glomerulonephritis, IGA
(mortality, pathology, therapy)
- Hematuria
(diagnosis)
- Humans
- Longitudinal Studies
- Male
- Middle Aged
- Prednisolone
(therapeutic use)
- Prognosis
- Proteinuria
(diagnosis)
- Remission Induction
- Risk Factors
- Survival Rate
- Tonsillectomy
- Young Adult
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