Tonsillectomy has beneficial effects on remission and progression of IgA nephropathy independent of steroid therapy.

Abstract

BACKGROUND:

Indication of tonsillectomy in IgA nephropathy is controversial. The purpose of this study was to examine the efficacy of tonsillectomy on remission and progression of IgA nephropathy.

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.

• 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)

Chemical References

• Anti-Inflammatory Agents
• Prednisolone

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