title: Tonsillectomy reduces recurrence of IgA nephropathy in mesangial hypercellularity type categorized by the Oxford classification.
abstract: BACKGROUND
  In patients with IgA nephropathy (IgAN), recurrence after steroid pulse therapy is associated with reduced renal survival. However, the predictors of recurrence have not yet been clarified.
  
  
  METHODS
  All patients who received 6-month steroid pulse therapy from 2004 to 2010 in our four affiliated hospitals and achieved a reduction of proteinuria to <0.4 g/day 1 year after treatment were retrospectively evaluated. The primary outcome was proteinuria ≥1.0 g/day during follow-up or additional antiproteinuric therapy. Two histological classifications were evaluated, the Oxford Classification with a split system and Japanese histological grades (HGs) with a lumped system.
  
  
  RESULTS
  During a median follow-up of 3.4 years, 27 (26.7 %) of the 101 patients showed recurrence. Multivariate analysis showed that HG was the only significant predictor of recurrence, with HG 2+3+4 vs HG 1 having a hazard ratio of 7.38 (95 % confidence interval 1.52-133). Furthermore, in patients with mesangial hypercellularity according to the Oxford Classification, cumulative rate of recurrence-free survival was greater in patients with steroid therapy plus tonsillectomy compared with those who received steroid therapy alone (Log-rank test, P = 0.022). However, this association was not observed in patients without mesangial hypercellularity.
  
  
  CONCLUSIONS
  HG is a novel predictor of recurrence after steroid pulse therapy in patients with IgAN. Moreover, the combination of steroid pulse therapy plus tonsillectomy may indicate a lower risk of recurrence in patients with mesangial hypercellularity, as defined by the Oxford Classification.
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Ashikaga Red Cross Hospital, 284-1 Yobe-cho, Ashikaga, Tochigi, 326-0843, Japan. khirano@jikei.ac.jp.|Division of Nephrology and Hypertension, Department of Internal Medicine, Jikei University School of Medicine, Minato, Tokyo, Japan. khirano@jikei.ac.jp.
authors.forename: Keita
authors.initials: K
authors.lastname: Hirano
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Ashikaga Red Cross Hospital, 284-1 Yobe-cho, Ashikaga, Tochigi, 326-0843, Japan.|Division of Nephrology and Hypertension, Department of Internal Medicine, Jikei University School of Medicine, Minato, Tokyo, Japan.
authors.forename: Hoichi
authors.initials: H
authors.lastname: Amano
authors.affiliation: Division of Nephrology and Hypertension, Department of Internal Medicine, Jikei University School of Medicine, Minato, Tokyo, Japan.
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Kawamura
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Ashikaga Red Cross Hospital, 284-1 Yobe-cho, Ashikaga, Tochigi, 326-0843, Japan.|Division of Nephrology and Hypertension, Department of Internal Medicine, Jikei University School of Medicine, Minato, Tokyo, Japan.
authors.forename: Kyoko
authors.initials: K
authors.lastname: Watanabe
authors.affiliation: Division of Nephrology and Hypertension, Department of Internal Medicine, Jikei University School of Medicine, Minato, Tokyo, Japan.
authors.forename: Kentaro
authors.initials: K
authors.lastname: Koike
authors.affiliation: Division of Nephrology and Hypertension, Department of Internal Medicine, Jikei University School of Medicine, Minato, Tokyo, Japan.
authors.forename: Akihiro
authors.initials: A
authors.lastname: Shimizu
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Ashikaga Red Cross Hospital, 284-1 Yobe-cho, Ashikaga, Tochigi, 326-0843, Japan.|Division of Nephrology and Hypertension, Department of Internal Medicine, Jikei University School of Medicine, Minato, Tokyo, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Endo
authors.affiliation: Division of Nephrology and Hypertension, Department of Internal Medicine, Jikei University School of Medicine, Minato, Tokyo, Japan.
authors.forename: Nobuo
authors.initials: N
authors.lastname: Tsuboi
authors.affiliation: Division of Nephrology and Hypertension, Department of Internal Medicine, Jikei University School of Medicine, Minato, Tokyo, Japan.
authors.forename: Hideo
authors.initials: H
authors.lastname: Okonogi
authors.affiliation: Division of Nephrology and Hypertension, Department of Internal Medicine, Jikei University School of Medicine, Minato, Tokyo, Japan.
authors.forename: Yoichi
authors.initials: Y
authors.lastname: Miyazaki
authors.affiliation: Division of Nephrology and Hypertension, Department of Internal Medicine, Jikei University School of Medicine, Minato, Tokyo, Japan.
authors.forename: Masato
authors.initials: M
authors.lastname: Ikeda
authors.affiliation: Division of Nephrology and Hypertension, Department of Internal Medicine, Jikei University School of Medicine, Minato, Tokyo, Japan.
authors.forename: Kazushige
authors.initials: K
authors.lastname: Hanaoka
authors.affiliation: Division of Nephrology and Hypertension, Department of Internal Medicine, Jikei University School of Medicine, Minato, Tokyo, Japan.
authors.forename: Makoto
authors.initials: M
authors.lastname: Ogura
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Ashikaga Red Cross Hospital, 284-1 Yobe-cho, Ashikaga, Tochigi, 326-0843, Japan.
authors.forename: Satoru
authors.initials: S
authors.lastname: Komatsumoto
authors.affiliation: Division of Nephrology and Hypertension, Department of Internal Medicine, Jikei University School of Medicine, Minato, Tokyo, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Yokoo
mesh_terms: D000328:Adult; D001706:Biopsy; D049109:Cell Proliferation; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D005260:Female; D005920:Glomerular Mesangium / Q000473:pathology*; D005922:Glomerulonephritis, IGA / Q000145:classification / Q000188:drug therapy / Q000473:pathology / Q000601:surgery*; D006801:Humans; D007564:Japan; D053208:Kaplan-Meier Estimate; D008297:Male; D011507:Proteinuria / Q000175:diagnosis / Q000188:drug therapy / Q000601:surgery; D020551:Pulse Therapy, Drug; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D013256:Steroids / Q000008:administration & dosage; D013997:Time Factors; D014068:Tonsillectomy; D016896:Treatment Outcome
chemical_list: D013256:Steroids
keywords: Corticosteroid therapy; Histological grade; IgA/C3 ratio; Mesangial hypercellularity; The Oxford classification; Tonsillectomy