The efficacy of tonsillectomy on long-term renal survival in patients with IgA nephropathy.
BACKGROUND
Little information has been available until now about the clinical efficacy of tonsillectomy on long-term renal survival of patients with idiopathic immunoglobulin A nephropathy (IgAN).


METHODS
To investigate the effect of tonsillectomy on long-term renal survival, we reviewed the clinical course of 118 patients with idiopathic biopsy-diagnosed IgAN from 1973 to 1980. Of those, 48 patients received tonsillectomy and 70 patients did not. The starting point of observation was defined as the time of the diagnostic renal biopsy, and the end point as when requiring the first dialysis. Up to 2001, the mean observation time was 192.9 +/- 74.8 months (48-326 months). Renal survival and impact of covariates were evaluated by Kaplan-Meier analysis and Cox proportional hazards regression model.


RESULTS
Age, gender, amount of urinary protein excretion, serum creatinine, serum IgA, blood pressure, and histopathologic findings at the time of renal biopsy and treatments during the observation period were not significantly different between patients with and without tonsillectomy. Five (10.4%) of the patients with tonsillectomy and 18 (25.7%) of the patients without tonsillectomy finally required dialysis therapy (chi-square test, P = 0.0393). By Kaplan-Meier analysis, renal survival rates were 89.6% and 63.7% at 240 months in the patients with and without tonsillectomy, respectively, and were significantly different (log-rank test, P = 0.0329). In the multivariate Cox regression model, tonsillectomy (hazard ratio, 0.22; 95% CI, 0.06 to 0.76; P = 0.0164) had a significant effect on renal outcome.


CONCLUSIONS
These results indicate that tonsillectomy has a favorable effect on long-term renal survival in patients with IgAN.
Xie
Yuansheng
Y
Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan.
Nishi
Shinichi
S
Ueno
Mitsuhiro
M
Imai
Naofumi
N
Sakatsume
Minoru
M
Narita
Ichiei
I
Suzuki
Yasushi
Y
Akazawa
Kouhei
K
Shimada
Hisaki
H
Arakawa
Masaaki
M
Gejyo
Fumitake
F
D000328:Adult; D001706:Biopsy; D005260:Female; D005500:Follow-Up Studies; D005922:Glomerulonephritis, IGA / Q000276:immunology / Q000601:surgery* / Q000628:therapy; D006801:Humans; D007668:Kidney / Q000276:immunology / Q000473:pathology; D008297:Male; D008875:Middle Aged; D014066:Palatine Tonsil / Q000276:immunology; D016016:Proportional Hazards Models; D012044:Regression Analysis; D006435:Renal Dialysis; D014068:Tonsillectomy; D016896:Treatment Outcome