title: Comparison of immunosuppressive therapies for IgA nephropathy after tonsillectomy: three-course versus one-course steroid pulse combined with mizoribine.
abstract: OBJECTIVE
  It has been reported that steroid pulse therapy for IgA nephropathy improves renal prognosis. However, because of the side effects, steroid dose must be restricted to some cases. Treatment effects of steroid on cases already presenting with reduced renal function are unknown. In this study, we performed tonsillectomy in patients with IgA nephropathy and conducted a comparative study about subsequent immunosuppressive therapy.
  
  
  METHODS
  Subjects were patients younger than 70 years of age diagnosed with IgA nephropathy by renal biopsy. Treatment protocols were a single-course steroid pulse combined with mizoribine during a period from August 2006 to June 2010 (Group A; n = 34) and a three-course steroid pulse during a period from July 2010 to March 2013 (Group B; n = 32). Primary end points were excretory amounts of proteinuria, disappearance of proteinuria and hematuria, and exacerbation of renal function.
  
  
  RESULTS
  In both the groups, proteinuria decreased significantly 12 months after treatment, and no significant difference in alleviation effects on proteinuria was found between groups. eGFR increased significantly 12 months after treatment in Group A, whereas it tended to decrease in Group B. As for the preservation effect on eGFR, Group A showed significantly higher preservation of eGFR. Similar results were shown in the patients whose eGFR at the start of the treatment was less than 60 mL/min/1.73 m(2).
  
  
  CONCLUSIONS
  Single-course steroid pulse therapy combined with mizoribine was considered to have a protective effect on the renal function in IgA nephropathy, especially accompanying renal dysfunction.
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan. tomohiro@nms.ac.jp.
authors.forename: Tomohiro
authors.initials: T
authors.lastname: Kaneko
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan. takemomoko@nms.ac.jp.
authors.forename: Momoko
authors.initials: M
authors.lastname: Arai
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan. maripon0107@yahoo.co.jp.
authors.forename: Mariko
authors.initials: M
authors.lastname: Ikeda
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan. f-megumi@nms.ac.jp.
authors.forename: Megumi
authors.initials: M
authors.lastname: Morita
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan. s9100@nms.ac.jp.
authors.forename: Yoko
authors.initials: Y
authors.lastname: Watanabe
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan. ahirama@nms.ac.jp.
authors.forename: Akio
authors.initials: A
authors.lastname: Hirama
authors.affiliation: Department of Analytic Human Pathology, Nippon Medical School, Tokyo, Japan. ashimizu@nms.ac.jp.
authors.forename: Akira
authors.initials: A
authors.lastname: Shimizu
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan. tsuruoka@nms.ac.jp.
authors.forename: Shuichi
authors.initials: S
authors.lastname: Tsuruoka
mesh_terms: D000328:Adult; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage*; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D005260:Female; D005919:Glomerular Filtration Rate; D005922:Glomerulonephritis, IGA / Q000150:complications / Q000188:drug therapy* / Q000601:surgery; D006417:Hematuria / Q000209:etiology; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage*; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage*; D008875:Middle Aged; D011239:Prednisolone / Q000008:administration & dosage*; D011507:Proteinuria / Q000209:etiology; D012263:Ribonucleosides / Q000008:administration & dosage*; D014068:Tonsillectomy; D055815:Young Adult
chemical_list: D000893:Anti-Inflammatory Agents; D007166:Immunosuppressive Agents; D012263:Ribonucleosides; C010052:mizoribine; D011239:Prednisolone; D008775:Methylprednisolone
keywords: IgA nephropathy; Mizoribine; Steroid pulse; Tonsillectomy