Tonsillectomy has beneficial effects on remission and progression of IgA nephropathy independent of steroid therapy

• Published in: Nephrology, dialysis, transplantation Vol. 27; no. 7; pp. 2806 - 2813
• Main Authors: MAEDA, Isseki, HAYASHI, Tomoshige, KONISHI, Masayo, KONISHI, Yoshio, ENDO, Ginji, IMANISHI, Masahito, KOGAWA SATO, Kyoko, OKUMOTO SHIBATA, Mikiko, HAMADA, Masahiro, KISHIDA, Masatsugu, KITABAYASHI, Chizuko, MORIKAWA, Takashi, OKADA, Noriyuki, OKUMURA, Michiaki
• Format: Journal Article
• Language: English
• Published: Oxford Oxford University Press 01-07-2012
• Subjects: Adult; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Anti-Inflammatory Agents - therapeutic use; Arterial Pressure; Biological and medical sciences; Cohort Studies; Disease Progression; Emergency and intensive care: renal failure. Dialysis management; Female; Follow-Up Studies; Glomerular Filtration Rate; Glomerulonephritis; Glomerulonephritis, IGA - mortality; Glomerulonephritis, IGA - pathology; Glomerulonephritis, IGA - therapy; Hematuria - diagnosis; Humans; Intensive care medicine; Longitudinal Studies; Male; Medical sciences; Middle Aged; Nephrology. Urinary tract diseases; Nephropathies. Renovascular diseases. Renal failure; Prednisolone - therapeutic use; Prognosis; Proteinuria - diagnosis; Remission Induction; Risk Factors; Survival Rate; Tonsillectomy; Young Adult; Kidney disease; Steroid; IgA; Urinary system disease; Hemodialysis; Extrarenal dialysis; Nephropathy; Treatment; IgA nephropathy; steroid therapy; Tonsillectomy; Deterioration; clinical remission; Renal failure; renal deterioration; Remission
• ISSN: 0931-0509; 1460-2385
• DOI: 10.1093/ndt/gfs053

Indication of tonsillectomy in IgA nephropathy is controversial. The purpose of this study was to examine the efficacy of tonsillectomy on remission and progression of IgA nephropathy.
We conducted a single-center 7-year historical cohort study in 200 patients with biopsy-proven IgA nephropathy. Study outcomes were clinical remission defined as disappearance of urine abnormalities at two consecutive visits, glomerular filtration rate (GFR) decline defined as 30% GFR decrease from baseline and GFR slope during the follow-up.
Seventy of the 200 patients received tonsillectomy. Tonsillectomy was associated with increased incidence of clinical remission (P+0.01, log-rank test) and decreased incidence of GFR decline (P=0.01, log-rank test). After adjustment for age and gender, hazard ratios in tonsillectomy were 3.90 (95% confidence interval 2.46-6.18) for clinical remission and 0.14 (0.02-1.03) for GFR decline. After further adjustment for laboratory (baseline mean arterial pressure, GFR, 24-h proteinuria and hematuria score), histological (mesangial score, segmental sclerosis or adhesion, endocapillary proliferation and interstitial fibrosis) or treatment variables (steroid and renin-angiotensin system inhibitors), similar results were obtained in each model. Even after exclusion of 69 steroid-treated patients, results did not change. GFR slopes in tonsillectomy and non-tonsillectomy groups were 0.60±3.65 and -1.64±2.59 mL/min/1.73 m2/year, respectively. In the multiple regression model, tonsillectomy prevented GFR decline during the follow-up period (regression coefficient 2.00, P=0.01).
Tonsillectomy was associated with a favorable renal outcome of IgA nephropathy in terms of clinical remission and delayed renal deterioration even in non-steroid-treated patients.