title: Significance of tonsillectomy combined with steroid pulse therapy for IgA nephropathy with mild proteinuria.
abstract: BACKGROUND
  Medical intervention for patients with IgA nephropathy and mild proteinuria (<1.0 g/day) is controversial, and the effectiveness of tonsillectomy plus steroid pulse therapy (TSP) for such patients remains obscure.
  
  
  METHODS
  Among 323 patients in our multicenter cohort study, 79 who had mild proteinuria (0.4-1.0 g/day) at diagnosis were eligible to participate in this study. We compared the clinicopathological findings at diagnosis, a decline in renal function defined as a 50 or 100% increase in serum creatinine (sCr) and clinical remission (CR) defined as the disappearance of hematuria and proteinuria (<0.3 g/day) among groups given TSP (n = 46), steroid therapy (ST) (n = 9), and non-ST (n = 24). Factors contributing to CR were also evaluated using multivariate analysis.
  
  
  RESULTS
  Background factors at diagnosis including age, ratio (%) of patients with hypertension, sCr, proteinuria, and histological severity did not significantly differ among the groups. Only two patients each in the TSP (4.3%) and non-ST (8.3%) groups achieved a 50% increase in sCr during a mean follow-up period of 4.7 years. At the final observation, 71.7, 44.4, and 41.7% of patients in the TSP, ST, and non-ST groups, respectively, achieved CR (p = 0.032). Cox proportional hazards models revealed that TSP led to CR more effectively than non-TSP by a factor of about threefold (hazard ratio, 2.74; p = 0.008).
  
  
  CONCLUSIONS
  TSP therapy has potential for inducing CR in patients with IgAN and mild proteinuria (<1.0 g/day).
authors.affiliation: First Department of Internal Medicine, University of Miyazaki Hospital, 5200 Kihara, Kiyotake, Miyazaki, 889-1692, Japan. hiroyuki_komatsu@med.miyazaki-u.ac.jp.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Komatsu
authors.affiliation: First Department of Internal Medicine, University of Miyazaki Hospital, 5200 Kihara, Kiyotake, Miyazaki, 889-1692, Japan.
authors.forename: Yuji
authors.initials: Y
authors.lastname: Sato
authors.affiliation: Second Department of Internal Medicine, University of Occupational and Environmental Health School of Medicine, Kitakyushu, Japan.
authors.forename: Tetsu
authors.initials: T
authors.lastname: Miyamoto
authors.affiliation: Second Department of Internal Medicine, University of Occupational and Environmental Health School of Medicine, Kitakyushu, Japan.
authors.forename: Masahito
authors.initials: M
authors.lastname: Tamura
authors.affiliation: Department of Endocrinology Metabolism, Rheumatology and Nephrology, Faculty of Medicine, Oita University, Oita, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Nakata
authors.affiliation: Blood Purification Center, Oita University of Hospital, Oita, Japan.
authors.forename: Tadashi
authors.initials: T
authors.lastname: Tomo
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: Second Department of Internal Medicine, Nagasaki University School of Medicine, Nagasaki, Japan.
authors.forename: Masanobu
authors.initials: M
authors.lastname: Miyazaki
authors.affiliation: Department of Hemovascular Medicine and Artificial Organs, Miyazaki University School of Medicine, Miyazaki, Japan.
authors.forename: Shouichi
authors.initials: S
authors.lastname: Fujimoto
mesh_terms: D000293:Adolescent; D000328:Adult; D015415:Biomarkers / Q000097:blood; D016009:Chi-Square Distribution; D003131:Combined Modality Therapy; D003404:Creatinine / Q000097:blood; D005260:Female; D005919:Glomerular Filtration Rate / Q000187:drug effects; D005922:Glomerulonephritis, IGA / Q000175:diagnosis / Q000276:immunology / Q000503:physiopathology / Q000628:therapy*; D006417:Hematuria / Q000517:prevention & control; D006801:Humans; D007564:Japan; D053208:Kaplan-Meier Estimate; D007668:Kidney / Q000187:drug effects / Q000276:immunology / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D011507:Proteinuria / Q000175:diagnosis / Q000276:immunology / Q000503:physiopathology / Q000628:therapy*; 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: D015415:Biomarkers; D013256:Steroids; D003404:Creatinine
keywords: Glomerulonephritis; IgA nephropathy; Remission; Steroid pulse therapy; Tonsillectomy