title: Impact of tonsillectomy combined with steroid pulse therapy on immunoglobulin A nephropathy depending on histological classification: a multicenter study.
abstract: BACKGROUND
  In addition to corticosteroids and inhibition of the renin-angiotensin-aldosterone system, tonsillectomy with steroid pulse therapy (TSP) may have a beneficial impact on the clinical course of IgA nephropathy (IgAN). However, there is still much uncertainty regarding the indications for therapy, treatment protocol, and therapeutic options for IgAN.
  
  
  METHODS
  In this multicenter retrospective cohort study, we enrolled 284 patients with biopsy-proven IgAN who received TSP or corticosteroid therapy or conservative therapy. The effects of TSP on clinical remission (CR) were evaluated after a median follow-up period of 4.1 years in relation to histological classifications.
  
  
  RESULTS
  Among the 284 participants, 161 patients received TSP. During the observation time, 141 patients (49.6%) achieved CR, with a median time to remission of 397 days. In multivariate Cox regression analyses, TSP had an impact on achieving CR in only the group with histological grade 3 defined as glomerulosclerosis, crescent formation or adhesion to Bowman's capsule in 10-30% of all biopsied glomeruli, or mild cellular infiltration in the interstitium (hazard ratio (HR) 4.29, 95% confidence interval (95%CI) 1.88-11.19, P < 0.001). TSP independently contributed to a higher incidence of CR, particularly in the patient group showing evident mesangial hypercellularity (HR 2.54, 95%CI 1.38-5.08, P = 0.002).
  
  
  CONCLUSIONS
  TSP may have a beneficial effect on the clinical course in IgAN patients with mild to moderate glomerular and interstitial lesions, particularly with distinct mesangial cell proliferation.
authors.affiliation: Second Department of Internal Medicine, University of Occupational and Environmental Health School of Medicine, Iseigaoka 1-1, Yahatanishi, Kitakyushu, Japan. tetsum@med.uoeh-u.ac.jp.
authors.forename: Tetsu
authors.initials: T
authors.lastname: Miyamoto
authors.affiliation: Second Department of Internal Medicine, Nagasaki University School of Medicine, Nagasaki, Japan.
authors.forename: Tomoya
authors.initials: T
authors.lastname: Nishino
authors.affiliation: Department of Endocrinology, Metabolism, Rheumatology and Nephrology, Faculty of Medicine, Oita University, Oita, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Nakata
authors.affiliation: Dialysis Division, University of Miyazaki Hospital, Miyazaki, Japan.
authors.forename: Yuji
authors.initials: Y
authors.lastname: Sato
authors.affiliation: First department of Internal Medicine, Miyazaki University School of Medicine, Miyazaki, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Komatsu
authors.affiliation: Second Department of Internal Medicine, Nagasaki University School of Medicine, Nagasaki, Japan.
authors.forename: Tadashi
authors.initials: T
authors.lastname: Uramatsu
authors.affiliation: Second Department of Internal Medicine, University of Occupational and Environmental Health School of Medicine, Iseigaoka 1-1, Yahatanishi, Kitakyushu, Japan.
authors.forename: Nana
authors.initials: N
authors.lastname: Ishimatsu
authors.affiliation: Department of Endocrinology, Metabolism, Rheumatology and Nephrology, Faculty of Medicine, Oita University, Oita, Japan.
authors.forename: Kaede
authors.initials: K
authors.lastname: Ishida
authors.affiliation: Kidney Center, University of Occupational and Environmental Health School of Medicine, Kitakyushu, Japan.
authors.forename: Ryota
authors.initials: R
authors.lastname: Serino
authors.affiliation: Second Department of Internal Medicine, University of Occupational and Environmental Health School of Medicine, Iseigaoka 1-1, Yahatanishi, Kitakyushu, Japan.
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Otsuji
authors.affiliation: Blood Purification Center, Oita University Hospital, Oita, Japan.
authors.forename: Masanobu
authors.initials: M
authors.lastname: Miyazaki
authors.affiliation: Miyazaki Naika Clinic, Nagasaki, Japan.
authors.forename: Tadashi
authors.initials: T
authors.lastname: Tomo
authors.affiliation: Kidney Center, University of Occupational and Environmental Health School of Medicine, Kitakyushu, Japan.
authors.forename: Masahito
authors.initials: M
authors.lastname: Tamura
authors.affiliation: Department of Hemovascular Medicine and Artificial Organs, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan.
authors.forename: Shouichi
authors.initials: S
authors.lastname: Fujimoto
mesh_terms: D000328:Adult; D001706:Biopsy; D016009:Chi-Square Distribution; D003131:Combined Modality Therapy; D005260:Female; D005922:Glomerulonephritis, IGA / Q000175:diagnosis / Q000276:immunology / Q000628:therapy*; D006801:Humans; D007564:Japan; D053208:Kaplan-Meier Estimate; D007678:Kidney Glomerulus / Q000187:drug effects* / Q000276:immunology / Q000473:pathology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D020551:Pulse Therapy, Drug; D012074:Remission Induction; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013256:Steroids / Q000008:administration & dosage*; D013997:Time Factors; D014068:Tonsillectomy; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D013256:Steroids
keywords: IgA nephropathy; Pathological classification; Tonsillectomy