title: 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).
  
  
  CONCLUSIONS
  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.affiliation: Department of Preventive Medicine and Environmental Health, Osaka City University Graduate School of Medicine, and Department of Nephrology and Hypertension, Osaka City General Hospital, Osaka, Japan.
authors.forename: Isseki
authors.initials: I
authors.lastname: Maeda
authors.forename: Tomoshige
authors.initials: T
authors.lastname: Hayashi
authors.forename: Kyoko Kogawa
authors.initials: KK
authors.lastname: Sato
authors.forename: Mikiko Okumoto
authors.initials: MO
authors.lastname: Shibata
authors.forename: Masahiro
authors.initials: M
authors.lastname: Hamada
authors.forename: Masatsugu
authors.initials: M
authors.lastname: Kishida
authors.forename: Chizuko
authors.initials: C
authors.lastname: Kitabayashi
authors.forename: Takashi
authors.initials: T
authors.lastname: Morikawa
authors.forename: Noriyuki
authors.initials: N
authors.lastname: Okada
authors.forename: Michiaki
authors.initials: M
authors.lastname: Okumura
authors.forename: Masayo
authors.initials: M
authors.lastname: Konishi
authors.forename: Yoshio
authors.initials: Y
authors.lastname: Konishi
authors.forename: Ginji
authors.initials: G
authors.lastname: Endo
authors.forename: Masahito
authors.initials: M
authors.lastname: Imanishi
mesh_terms: D000328:Adult; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D062186:Arterial Pressure; D015331:Cohort Studies; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D005922:Glomerulonephritis, IGA / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D006417:Hematuria / Q000175:diagnosis; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011239:Prednisolone / Q000627:therapeutic use*; D011379:Prognosis; D011507:Proteinuria / Q000175:diagnosis; D012074:Remission Induction; D012307:Risk Factors; D015996:Survival Rate; D014068:Tonsillectomy; D055815:Young Adult
chemical_list: D000893:Anti-Inflammatory Agents; D011239:Prednisolone