title: Impact of periodontal treatment in combination with tonsillectomy plus methylprednisolone pulse therapy and angiotensin blockade for pediatric IgA nephropathy.
abstract: BACKGROUND
  We previously reported the efficacy of extensive eradication of infectious foci in oral and ENT lesions, combined with tonsillectomy plus methylprednisolone (MP) pulse therapy, for curing pediatric Henoch-Schönlein purpura (HSP) and HSP nephritis. In the present study, we used this therapy in patients with pediatric IgA nephropathy (IgAN) to assess whether similar results could be obtained.
  
  
  METHODS
  In 11 pediatric patients newly diagnosed with IgAN, exploration for infectious foci showed severe oral infection, including dental caries and apical periodontitis, in many. The overall decayed, missing and filled teeth score was elevated to 5.91. Two patients had rhinosinusitis. After extensive treatment of infectious foci, patients underwent tonsillectomy plus MP pulse therapy with angiotensin II receptor blockade.
  
  
  RESULTS
  Clinical remission was achieved in all patients with pediatric IgAN (various histologic grades). Remission was achieved by 7.2 ± 5.7 months after initiation of steroid therapy, and disappearance of proteinuria by 3.3 ± 3.0 months. The mean duration of oral steroid administration was 9.5 ± 3.6 months. No relapse has occurred during follow-up of 4.3 ± 2.4 y.
  
  
  CONCLUSIONS
  Careful examination and thorough elimination of infectious foci in oral and ENT lesions can optimize the effect of tonsillectomy plus MP pulse therapy, promoting recovery from IgAN.
authors.affiliation: Department of Pediatrics, Department of Otolaryngology, Red Cross Sendai Hospital, Sendai, Japan. chnagano@sendai.jrc.or.jp
authors.forename: Chiyoko N
authors.initials: CN
authors.lastname: Inoue
authors.forename: Sachiko
authors.initials: S
authors.lastname: Matsutani
authors.forename: Masako
authors.initials: M
authors.lastname: Ishidoya
authors.forename: Rikako
authors.initials: R
authors.lastname: Homma
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Chiba
authors.forename: Takako
authors.initials: T
authors.lastname: Nagasaka
mesh_terms: D000293:Adolescent; D057911:Angiotensin Receptor Antagonists / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D005260:Female; D005922:Glomerulonephritis, IGA / Q000628:therapy*; D006801:Humans; D011695:IgA Vasculitis / Q000628:therapy; D008297:Male; D008775:Methylprednisolone / Q000627:therapeutic use*; D010518:Periodontitis / Q000628:therapy*; D014068:Tonsillectomy
chemical_list: D057911:Angiotensin Receptor Antagonists; D008775:Methylprednisolone