Tonsillectomy and steroid pulse therapy significantly impact on clinical remission in patients with IgA nephropathy

• Published in: American journal of kidney diseases Vol. 38; no. 4; pp. 736 - 743
• Main Authors: Hotta, Osamu, Miyazaki, Mariko, Furuta, Takashi, Tomioka, Sachiko, Chiba, Shigemi, Horigome, Ikuo, Abe, Keishi, Taguma, Yoshio
• Format: Journal Article
• Language: English
• Published: Orlando, FL Elsevier Inc 01-10-2001; Elsevier
• Subjects: Adolescent; Adult; Anti-Inflammatory Agents - therapeutic use; Biological and medical sciences; clinical remission; Cyclophosphamide - therapeutic use; Disease Progression; Female; Follow-Up Studies; Glomerulonephritis; Glomerulonephritis, IGA - complications; Glomerulonephritis, IGA - therapy; Humans; Immunoglobulin A (IgA) nephropathy; Immunosuppressive Agents - therapeutic use; Kidney Failure, Chronic - etiology; Male; Medical sciences; Methylprednisolone - therapeutic use; Middle Aged; Nephrology. Urinary tract diseases; Nephropathies. Renovascular diseases. Renal failure; Proportional Hazards Models; Remission Induction; Retrospective Studies; steroid pulse therapy; Tonsillectomy; steroid pulse therapy; Immunoglobulin A (IgA) nephropathy; tonsillectomy; clinical remission; Kidney disease; Human; Glomerulonephritis; Immunopathology; Corticosteroid; IgA; Urinary system disease; Steroid hormone; Methylprednisolone; Chemotherapy; Treatment; Tonsillectomy; Surgery; Remission; Immunosuppressive agent; Aggravation; High dose
• ISSN: 0272-6386; 1523-6838
• DOI: 10.1053/ajkd.2001.27690

We conducted a retrospective investigation of renal outcome in 329 patients with immunoglobulin A (IgA) nephropathy with an observation period longer than 36 months (82.3 ± 38.2 months) in our renal unit between 1977 and 1995. Clinical remission, renal progression, and the impact of covariates were estimated by Kaplan-Meier analysis and a Cox regression model. In 157 of 329 patients (48%), disappearance of urinary abnormalities (clinical remission) was obtained. None of these 157 patients showed progressive deterioration, defined as a 50% increase in serum creatinine (Scr) level from baseline, during the observation period. Conversely, in patients without clinical remission, the Kaplan-Meier estimate of probability of progressive deterioration was 21% ± 5% at 10 years. In the multivariate Cox regression model with 13 independent covariates, initial Scr level, histological score, tonsillectomy, and high-dose methylprednisolone therapy had a significant impact on clinical remission, whereas proteinuria, age, sex, levels of hematuria, blood pressure, conventional steroid therapy, angiotensin-converting enzyme inhibitor therapy, and cyclophosphamide therapy had no significant effect. These findings indicate that interventions aimed at achieving clinical remission have provided encouraging results applicable to managing patients with IgA nephropathy. © 2001 by the National Kidney Foundation, Inc.