Retrospective comparison of the efficacy of tonsillectomy with and without steroid-pulse therapy in IgA nephropathy patients.
OBJECTIVE
Tonsillectomy and steroid-pulse (TSP) therapy have been proposed as a curative treatment for immunoglobulin A nephropathy (IgAN) in Japan. However, we sometimes encounter patients who reject steroid-pulse therapy because of concerns about the side effects of corticosteroids. Here, we examined the efficacy of TSP therapy and tonsillectomy alone for IgAN with urinary abnormalities.


METHODS
Data on 40 IgAN patients diagnosed by renal biopsies, who presented glomerular hematuria and proteinuria at baseline and underwent bilateral palatine tonsillectomy, were analyzed retrospectively. Twenty of them underwent TSP therapy (TSP group), and 20 underwent tonsillectomy alone (T group). We examined associations between therapies, changes in urinary findings and renal function, and subsequent clinical remission (CR), defined as negative proteinuria and urinary erythrocytes of less than 5/high-power field.


RESULTS
TSP group showed a significant decrease in proteinuria and hematuria earlier than T group. The rates of CR were significantly higher in TSP group compared with T group on the final observation period (75% vs. 45%, p<0.05). There was a significant difference between CR group and non-CR group only in the rate of receiving TSP therapy.


CONCLUSIONS
TSP therapy significantly increased the probability of CR compared with tonsillectomy alone in IgAN patients with urinary abnormalities.
Division of Cardiology, Nephrology, Pulmonology and Neurology, Department of Internal Medicine, Asahikawa Medical University, Japan. naka-nao@asahikawa-med.ac.jp
Naoki
N
Nakagawa
Maki
M
Kabara
Motoki
M
Matsuki
Junko
J
Chinda
Takayuki
T
Fujino
Tomoya
T
Hirayama
Miki
M
Takahara
Yasuaki
Y
Harabuchi
Kenjiro
K
Kikuchi
Naoyuki
N
Hasebe
D000328:Adult; D003131:Combined Modality Therapy; D005260:Female; D005919:Glomerular Filtration Rate; D005922:Glomerulonephritis, IGA / Q000188:drug therapy* / Q000503:physiopathology / Q000601:surgery*; D006417:Hematuria / Q000628:therapy; D006801:Humans; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage*; D008875:Middle Aged; D014066:Palatine Tonsil / Q000601:surgery; D011507:Proteinuria / Q000628:therapy; D012074:Remission Induction; D012189:Retrospective Studies; D014068:Tonsillectomy; D016896:Treatment Outcome; D055815:Young Adult
D008775:Methylprednisolone