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- Title
Tonsillectomy has beneficial effects on remission and progression of IgA nephropathy independent of steroid therapy.
- Authors
Maeda, Isseki; Hayashi, Tomoshige; Sato, Kyoko Kogawa; Shibata, Mikiko Okumoto; Hamada, Masahiro; Kishida, Masatsugu; Kitabayashi, Chizuko; Morikawa, Takashi; Okada, Noriyuki; Okumura, Michiaki; Konishi, Masayo; Konishi, Yoshio; Endo, Ginji; Imanishi, Masahito
- Abstract
Tonsillectomy is being frequently used in Japan, while Western nephrologists are more reluctant to adopt tonsillectomy as a treatment for IgANâ¦(In this issue of NDT) Isseki et al. report the outcome of 200 Japanese patients with biopsy-proven IgAN followed in mean for up to 7 years after renal biopsy.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.
- Subjects
TONSILLECTOMY; IGA glomerulonephritis; KIDNEY diseases; STEROID drugs; MULTIPLE regression analysis; COHORT analysis; NEPHROLOGY; THERAPEUTICS
- Publication
Nephrology Dialysis Transplantation, 2012, Vol 27, Issue 7, p2806
- ISSN
0931-0509
- Publication type
Article
- DOI
10.1093/ndt/gfs053