title: Tonsillectomy and corticosteroid therapy with concomitant methylprednisolone pulse therapy for IgA nephropathy.
abstract: IgA nephropathy (IgAN) is the most common chronic kidney disease in Japan, but the optimum treatment remains controversial. Our objective was to evaluate the effect of tonsillectomy and corticosteroid therapy combined with methylprednisone pulse therapy in patients at our hospital who had IgAN. Tonsillectomy plus pulse therapy was evaluated in 72 patients (33 men and 39 women) with a diagnosis of IgAN based on renal biopsy who were followed up for more than 1 year. The mean age of the patients was 35.2 +/- 10.9 years (range: 20-58 years) and the mean observation period after tonsillectomy was 20.3 +/- 9.7 months (range: 12-36 months). After tonsillectomy, steroid pulse therapy was administered (methylprednisolone at 500 mg daily for 3 days) 1-3 times and was followed by oral prednisolone from an initial dose of 30 mg on alternate days that was tapered gradually over one year. At 2 years after tonsillectomy, serum creatinine was unchanged or improved in the majority of patients, but worsened in 5 patients. Hematuria (erythrocytes/HPF) improved from Grade 3.76 (11-30/HPF) to Grade 1.94 (1-5/HPF) on average (we defined the grade of hematuria). None of the patients experienced exacerbation of hematuria. Proteinuria decreased from 1.32 g/day to 0.86 g/day (65% of the pretreatment value), and only 4 patients showed an increase of proteinuria. Mean protein loss decreased to less than 0.5 g/day in patients with creatinine clearance > or =90 ml/min and/or patients with initial protein excretion < or =1.0 g/day.
authors.affiliation: Nephrology Center, Toranomon Hospital, Tokyo, Japan. suwabe@toranomon.gr.jp
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Suwabe
authors.forename: Yoshifumi
authors.initials: Y
authors.lastname: Ubara
authors.forename: Yoko
authors.initials: Y
authors.lastname: Sogawa
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Higa
authors.forename: Kazufumi
authors.initials: K
authors.lastname: Nomura
authors.forename: Shohei
authors.initials: S
authors.lastname: Nakanishi
authors.forename: Jyunichi
authors.initials: J
authors.lastname: Hoshino
authors.forename: Naoki
authors.initials: N
authors.lastname: Sawa
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Katori
authors.forename: Fumi
authors.initials: F
authors.lastname: Takemoto
authors.forename: Shigeko
authors.initials: S
authors.lastname: Hara
authors.forename: Kenichi
authors.initials: K
authors.lastname: Ohashi
authors.forename: Kenmei
authors.initials: K
authors.lastname: Takaichi
mesh_terms: D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D005922:Glomerulonephritis, IGA / Q000188:drug therapy* / Q000601:surgery*; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008775:Methylprednisolone / Q000627:therapeutic use*; D008875:Middle Aged; D020551:Pulse Therapy, Drug; D014068:Tonsillectomy; D016896:Treatment Outcome
chemical_list: D005938:Glucocorticoids; D008775:Methylprednisolone