title: Tonsillectomy with steroid pulse therapy has more effect on the relapse rate than steroid pulse monotherapy in IgA nephropathy patients.
abstract: OBJECTIVE
  Both steroid pulse (SP) monotherapy and the combination of tonsillectomy and SP therapy (TSP) are effective for achieving clinical remission (CR), defined as negative hematuria and proteinuria, in patients with IgA nephropathy (IgAN). The role of tonsillectomy in the treatment of IgAN has been analyzed only from the aspect of CR or renal survival after TSP treatment, so there is no evidence of its effect on the relapse after CR.
  
  
  METHODS
  We retrospectively investigated relapse (re-appearance of urinary abnormalities) from CR after TSP or SP monotherapy in 62 IgAN patients (mean follow-up, 70.1 ± 35.3 months). The SP therapy comprised 0.5 g methylprednisolone administered intravenously on 3 consecutive days followed by oral prednisolone (30 mg/day) on 4 consecutive days, with the course repeated 3 times. Oral prednisolone (30 mg/day) was then given on alternative days and gradually tapered and finished over 1 year. Tonsillectomy was performed either before or within 6 months of starting SP therapy.
  
  
  RESULTS
  At baseline, the mean age was 34.6 years, the mean serum creatinine (Cr) level was 0.9 mg/dl, and the mean level of proteinuria was 876 mg/day. There were no differences between the TSP group (41 patients) and SP monotherapy group (21 patients). In total, 24 of the TSP and 10 of the SP patients achieved CR. Of the 34 patients who achieved CR, 13 relapsed after TSP or SP monotherapy. Using Kaplan-Meier analysis, tonsillectomy was associated with a lower incidence of relapse from CR after treatment (p = 0.045). Multivariate Cox regression analysis revealed that tonsillectomy reduced the rate of from CR after SP therapy.
  
  
  CONCLUSIONS
  Tonsillectomy was associated with a reduction in the relapse rate from CR after SP therapy in IgAN patients.
authors.affiliation: Department of Internal Medicine, Wakayam Medical University, Wakayama City, Japan. m-ohya@wakayama-med.ac.jp
authors.forename: Masaki
authors.initials: M
authors.lastname: Ohya
authors.forename: Haruhisa
authors.initials: H
authors.lastname: Otani
authors.forename: Yoshinobu
authors.initials: Y
authors.lastname: Minami
authors.forename: Shintaro
authors.initials: S
authors.lastname: Yamanaka
authors.forename: Toru
authors.initials: T
authors.lastname: Mima
authors.forename: Shigeo
authors.initials: S
authors.lastname: Negi
authors.forename: Susumu
authors.initials: S
authors.lastname: Yukawa
authors.forename: Takashi
authors.initials: T
authors.lastname: Shigematsu
mesh_terms: D000328:Adult; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D003131:Combined Modality Therapy; D003404:Creatinine / Q000097:blood; D005260:Female; D005922:Glomerulonephritis, IGA / Q000097:blood / Q000628:therapy* / Q000652:urine; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage* / Q000627:therapeutic use; D008875:Middle Aged; D015999:Multivariate Analysis; D011239:Prednisolone / Q000008:administration & dosage; D016016:Proportional Hazards Models; D011507:Proteinuria / Q000652:urine; D012008:Recurrence; D012074:Remission Induction / Q000379:methods; D012189:Retrospective Studies; D014068:Tonsillectomy; D055815:Young Adult
chemical_list: D000893:Anti-Inflammatory Agents; D011239:Prednisolone; D003404:Creatinine; D008775:Methylprednisolone