Impact of the new risk stratification in the 2011 Japanese Society of Nephrology clinical guidelines for IgA nephropathy on incidence of early clinical remission with tonsillectomy plus steroid pulse therapy.
BACKGROUND
In 2011, the Japanese Society of Nephrology (JSN) published new clinical guidelines for IgA nephropathy (IgAN) with a new risk stratification based on clinical and histological severity. For classification, patients are divided into four groups (low, medium, high, and very high risk). However, differences in responsiveness to each treatment among different groups remain unclear. We evaluate the responsiveness of tonsillectomy plus steroid pulse (TSP) therapy using the new risk stratification.


METHODS
We retrospectively reviewed 111 IgAN patients with TSP therapy between January 2003 and January 2013. Study patients were divided into three groups [low- (n = 40), medium- (n = 43) and high-/very high-risk group (n = 28)]. The primary outcome was clinical remission (CR). The observation period was 1 year following tonsillectomy.


RESULTS
57 out of 111 patients (51.4 %) reached CR. The CR incidence was 70.0, 41.9 and 39.3 % (the low-, the medium- and the high-/very high-risk group, respectively). The incidence of CR was significantly higher in the low-risk group (P = 0.013). In a multivariate logistic regression analysis, both the medium- and the high-/very high-risk group showed significantly lower incidence of inducing CR than the low-risk group [(odds ratio 0.324; 95 % confidence interval 0.106-0.939, P = 0.041) (odds ratio 0.239; 95 % confidence interval 0.058-0.910, P = 0.040), respectively].


CONCLUSIONS
The new risk stratification in the 2011 JSN clinical guidelines for IgAN had a positive impact on early CR of TSP therapy.
Division of Nephrology, Department of Medicine, Showa University Fujigaoka Hospital, 1-30 Fujigaoka, Aoba-ku, Yokohama, 227-8501, Japan, ynaga1147@hotmail.co.jp.
Yoshikuni
Y
Nagayama
Hiroki
H
Nishiwaki
Takeshi
T
Hasegawa
Daisuke
D
Komukai
Eri
E
Kawashima
Mamiko
M
Takayasu
Hironori
H
Tayama
Yoshihiko
Y
Inoue
Kiyoko
K
Inui
Ashio
A
Yoshimura
D000328:Adult; D005260:Female; D005922:Glomerulonephritis, IGA / Q000188:drug therapy* / Q000453:epidemiology / Q000601:surgery*; D005938:Glucocorticoids / Q000008:administration & dosage*; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage*; D008875:Middle Aged; D015999:Multivariate Analysis; D012074:Remission Induction; D012189:Retrospective Studies; D018570:Risk Assessment; D014068:Tonsillectomy; D055815:Young Adult
D005938:Glucocorticoids; D008775:Methylprednisolone