title: Tonsillectomy for IgA nephropathy: a meta-analysis.
abstract: BACKGROUND
  The efficacy of tonsillectomy in immunoglobulin A nephropathy (IgAN) remains controversial. Our meta-analysis was intended to investigate its efficacy as an adjunct or independent treatment.
  
  
  METHODS
  Meta-analysis of prospective and retrospective studies using PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials.
  
  
  METHODS
  Patients with IgAN treated with or without tonsillectomy.
  
  
  METHODS
  Studies that compared clinical remission or end-stage renal disease (ESRD) in patients with IgAN with or without tonsillectomy.
  
  
  METHODS
  Tonsillectomy.
  
  
  RESULTS
  Clinical remission and ESRD.
  
  
  RESULTS
  14 studies (1,794 patients) were included and a random-effects model was applied. There were significantly greater odds of clinical remission with tonsillectomy (10 studies, 1,431 patients; pooled OR, 3.40; 95% CI, 2.58-4.48; P<0.001). Sensitivity analysis to exclude the effects of renin-angiotensin system inhibitors yielded consistent results (6 studies, 671 patients; pooled OR for remission, 2.80; 95% CI, 1.91-4.09; P<0.001). In subgroup analysis of the remission outcome, tonsillectomy plus steroid pulse therapy was superior to steroid pulse therapy alone (7 studies, 783 patients; pooled OR, 3.15; 95% CI, 1.99-5.01; P<0.001), and tonsillectomy plus conventional steroid therapy was superior to conventional steroid therapy alone (2 studies, 159 patients; pooled OR, 4.13; 95% CI, 1.23-13.94; P=0.02). Tonsillectomy was superior to general treatment (3 studies, 187 patients; pooled OR for remission, 2.21; 95% CI, 1.20-4.05; P=0.01). In addition, tonsillectomy was associated with decreased odds of ESRD (9 studies, 873 patients; pooled OR, 0.25; 95% CI, 0.12-0.52; P<0.001). 2 sensitivity analyses, one excluding studies with less than 5 years' follow-up and another excluding the confounding effect of renin-angiotensin system inhibitors, yielded nearly the same reduction in ESRD risk (6 studies, 691 patients; pooled OR, 0.20; 95% CI, 0.11-0.36; P<0.001; and 6 studies, 547 patients; pooled OR, 0.24; 95% CI, 0.14-0.44; P<0.001).
  
  
  CONCLUSIONS
  Most included studies were retrospective cohort studies; we were unable to adjust uniformly for potential confounding variables.
  
  
  CONCLUSIONS
  As adjunct or independent therapy, tonsillectomy may induce clinical remission and reduce the rates of ESRD in patients with IgAN.
authors.affiliation: Department of Nephrology, The First Affiliated Hospital of China Medical University, Shen Yang, People's Republic of China.
authors.forename: Lin-lin
authors.initials: LL
authors.lastname: Liu
authors.affiliation: Department of Nephrology, The First Affiliated Hospital of China Medical University, Shen Yang, People's Republic of China. Electronic address: catherine_cmu@yahoo.com.
authors.forename: Li-ning
authors.initials: LN
authors.lastname: Wang
authors.affiliation: Central Laboratory, The First Affiliated Hospital of China Medical University, Shen Yang, People's Republic of China.
authors.forename: Yi
authors.initials: Y
authors.lastname: Jiang
authors.affiliation: Department of Nephrology, The First Affiliated Hospital of China Medical University, Shen Yang, People's Republic of China.
authors.forename: Li
authors.initials: L
authors.lastname: Yao
authors.affiliation: The Library of China Medical University, Shen Yang, People's Republic of China.
authors.forename: Li-ping
authors.initials: LP
authors.lastname: Dong
authors.affiliation: Department of Nephrology, The First Affiliated Hospital of China Medical University, Shen Yang, People's Republic of China.
authors.forename: Zi-long
authors.initials: ZL
authors.lastname: Li
authors.affiliation: Department of Nephrology, The First Affiliated Hospital of China Medical University, Shen Yang, People's Republic of China.
authors.forename: Xiao-li
authors.initials: XL
authors.lastname: Li
mesh_terms: D000305:Adrenal Cortex Hormones / Q000008:administration & dosage*; D057186:Comparative Effectiveness Research; D005922:Glomerulonephritis, IGA / Q000150:complications / Q000628:therapy; D006801:Humans; D007676:Kidney Failure, Chronic / Q000209:etiology / Q000517:prevention & control; D017063:Outcome Assessment, Health Care; D020551:Pulse Therapy, Drug / Q000379:methods / Q000706:statistics & numerical data; D012189:Retrospective Studies; D014068:Tonsillectomy / Q000379:methods / Q000706:statistics & numerical data
chemical_list: D000305:Adrenal Cortex Hormones
keywords: IgA nephropathy (IgAN); clinical remission; end-stage renal disease (ESRD); glomerulonephritis; kidney disease progression; kidney failure; meta-analysis; tonsillectomy; tonsillitis