Long-Term Beneficial Effects of Tonsillectomy on Patients with Immunoglobulin A Nephropathy

• Published in: Kidney360 Vol. 1; no. 11; pp. 1270 - 1283
• Main Authors: Moriyama, Takahito, Karasawa, Kazunori, Miyabe, Yoei, Akiyama, Kenichi, Iwabuchi, Yuko, Ogura, Shota, Takabe, Tomo, Sugiura, Naoko, Seki, Momoko, Hanafusa, Norio, Uchida, Keiko, Nitta, Kosaku
• Format: Journal Article
• Language: English
• Published: United States American Society of Nephrology 25-11-2020
• Subjects: Glomerulonephritis, IGA - surgery; Humans; Kidney - surgery; Original Investigations; Proteinuria - complications; Retrospective Studies; Tonsillectomy - adverse effects; IgA glomerulonephritis; tonsillectomy; IgA nephropathy; clinical nephrology; prognosis
• ISSN: 2641-7650; 2641-7650
• DOI: 10.34067/KID.0003932020

Tonsillectomy may treat IgA nephropathy (IgAN) by reducing the levels of galactose-deficient IgA1. Therefore, we aimed to analyze the long-term effects of tonsillectomy on patients with IgAN, as an initial treatment and as a treatment at any time in their lives.
In this retrospective cohort analysis, 1147 patients with IgAN were grouped according to whether they had undergone tonsillectomy at any time, >1 year after renal biopsy (study 1), or within 1 year after renal biopsy (study 2). The patients were propensity-score matched or divided into four groups according to their proteinuria and renal function. The 20-year renal survival rates were evaluated until serum creatinine levels doubled (primary end point) and ESKD occurred (secondary end point).
Patients in both studies had similar background characteristics after propensity score matching. In study 1, the renal survival rates for the primary and secondary end points were significantly higher for patients who underwent tonsillectomy at any time or >1 year after renal biopsy compared with those who did not. In study 2, the renal survival rates for the primary and secondary end points were significantly higher for patients who underwent tonsillectomy soon after renal biopsy compared with those who did not (primary end point, 98% versus 69%,
=0.001; secondary end point, 100% versus 75%,
=0.0001). A stratified analysis showed that significant treatment efficacy was observed for patients with proteinuria >1.0 g/d. Multivariate Cox regression analyses showed that tonsillectomy was associated with disease progression (hazard ratio, 0.27;
=0.04). Complications associated with tonsillectomy occurred in 8% of patients.
Among patients with IgAN, tonsillectomy at any time of life, or soon after renal biopsy, prevents disease progression, and the procedure is relatively safe.