title: Comparison of effective impact among tonsillectomy alone, tonsillectomy combined with oral steroid and with steroid pulse therapy on long-term outcome of immunoglobulin A nephropathy.
abstract: BACKGROUND
  To clarify the therapeutic impact of tonsillectomy and combined therapies of tonsillectomy plus steroid on the long-term prognosis of immunoglobulin A nephropathy (IgAN).
  
  
  METHODS
  A retrospective study was conducted on 208 patients with IgAN between 1986 and 2009. According to the strategies for treatments, patients were divided into four groups: tonsillectomy and steroid pulse (TSP, n = 47), tonsillectomy and oral steroid (TOS, n = 33), tonsillectomy alone (T, n = 56), and N group (no particular therapy, n = 72). Multivariate analysis based on the Cox's regression model was used to assess the relative risk of reaching the outcome of doubling creatinine based on the influence of baseline prognostic factors.
  
  
  RESULTS
  The mean observation periods were 53.8 months in the TSP group, 122.0 months in the TOS group, 102.9 months in the T group, and 84.6 months in the N group. During an observation period, serum creatinine levels doubled as follows: one in the TSP group (2.1 %), two in the TOS group (6.1 %), five in the T group (8.9 %), histological severity, and 22 in the N group (30.6 %). The Cox's regression proportional hazard model showed that gender, age, histological activity, dialysis induction risk and therapy were associated with doubling creatinine levels. Hazard ratios (95 % CI) and (P value) in T, TOS, and TSP groups versus N were 0.314 (0.11-0.93, P = 0.037), 0.213 (0.04-1.10, P = 0.065), and 0.032 (0.00-0.28, P = 0.002), respectively.
  
  
  CONCLUSIONS
  A combination therapy of tonsillectomy and steroid pulse had the most significant therapeutic impact compared to other therapies.
authors.affiliation: Department of Nephrology, Fujita Health University Hospital, 1-98 Dengakugakubo Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan.
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Yamamoto
authors.forename: Yoshiyuki
authors.initials: Y
authors.lastname: Hiki
authors.forename: Shigeru
authors.initials: S
authors.lastname: Nakai
authors.forename: Koichiro
authors.initials: K
authors.lastname: Yamamoto
authors.forename: Kazuo
authors.initials: K
authors.lastname: Takahashi
authors.forename: Shigehisa
authors.initials: S
authors.lastname: Koide
authors.forename: Kazutaka
authors.initials: K
authors.lastname: Murakami
authors.forename: Makoto
authors.initials: M
authors.lastname: Tomita
authors.forename: Midori
authors.initials: M
authors.lastname: Hasegawa
authors.forename: Shiro
authors.initials: S
authors.lastname: Kawashima
authors.forename: Satoshi
authors.initials: S
authors.lastname: Sugiyama
authors.forename: Yukio
authors.initials: Y
authors.lastname: Yuzawa
mesh_terms: D000328:Adult; D000893:Anti-Inflammatory Agents / Q000009:adverse effects / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D003404:Creatinine / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D005920:Glomerular Mesangium / Q000473:pathology; D005922:Glomerulonephritis, IGA / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D006801:Humans; D007070:Immunoglobulin A / Q000032:analysis; D007677:Kidney Function Tests; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016016:Proportional Hazards Models; D012044:Regression Analysis; D006435:Renal Dialysis; D051437:Renal Insufficiency / Q000453:epidemiology / Q000209:etiology; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013256:Steroids / Q000009:adverse effects / Q000627:therapeutic use*; D014068:Tonsillectomy / Q000009:adverse effects; D016896:Treatment Outcome
chemical_list: D000893:Anti-Inflammatory Agents; D007070:Immunoglobulin A; D013256:Steroids; D003404:Creatinine