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Impact of the new risk stratification in the 2011 Japanese Society of Nephrology clinical guidelines for IgA nephropathy on incidence of early clinical remission with tonsillectomy plus steroid pulse therapy

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Abstract

Background

In 2011, the Japanese Society of Nephrology (JSN) published new clinical guidelines for IgA nephropathy (IgAN) with a new risk stratification based on clinical and histological severity. For classification, patients are divided into four groups (low, medium, high, and very high risk). However, differences in responsiveness to each treatment among different groups remain unclear. We evaluate the responsiveness of tonsillectomy plus steroid pulse (TSP) therapy using the new risk stratification.

Methods

We retrospectively reviewed 111 IgAN patients with TSP therapy between January 2003 and January 2013. Study patients were divided into three groups [low- (n = 40), medium- (n = 43) and high-/very high-risk group (n = 28)]. The primary outcome was clinical remission (CR). The observation period was 1 year following tonsillectomy.

Results

57 out of 111 patients (51.4 %) reached CR. The CR incidence was 70.0, 41.9 and 39.3 % (the low-, the medium- and the high-/very high-risk group, respectively). The incidence of CR was significantly higher in the low-risk group (P = 0.013). In a multivariate logistic regression analysis, both the medium- and the high-/very high-risk group showed significantly lower incidence of inducing CR than the low-risk group [(odds ratio 0.324; 95 % confidence interval 0.106–0.939, P = 0.041) (odds ratio 0.239; 95 % confidence interval 0.058–0.910, P = 0.040), respectively].

Conclusions

The new risk stratification in the 2011 JSN clinical guidelines for IgAN had a positive impact on early CR of TSP therapy.

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References

  1. Radford MG, Donadio JV, Bergstralh EJ, Grande JP. Predicting renal outcome in IgA nephropathy. J Am Soc Nephrol. 1997;8:199–207.

    PubMed  Google Scholar 

  2. D’Amico G, Minetti L, Ponticelli C, Fellin G, Ferrario F, Di Belgioioso GB, et al. Prognostic indicators in idiopathic IgA mesangial nephropathy. Q J Med. 1986;59:363–78.

  3. Berthoux F, Mohey H, Laurent B, Mariat C, Afiani A, Thibaudin L. Predicting the risk for dialysis or death in IgA nephropathy. J Am Soc Nephrol. 2011;22:752–61.

  4. Reich HN, Troyanov S, Scholey JW, Cattran DC for the Toronto Glomerulonephritis Registry. Remission of proteinuria improves prognosis in IgA Nephropathy. J Am Soc Nephrol 2007;18:3177–83.

  5. Bonnet F, Deprele C, Sassolas A, Moulin P, Alamartine E, Berthezène F, et al. Excessive body weight as a new independent risk factor for clinical and pathological progression in primary IgA nephritis. Am J Kidney Dis. 2001;37:720–7.

    Article  CAS  PubMed  Google Scholar 

  6. Yamamoto R, Nagasawa Y, Shoji T, Iwatani H, Hamano T, Kawada N, et al. Cigarette smoking and progression of IgA nephropathy. Am J Kidney Dis. 2010;56:313–24.

  7. Goto M, Wakai K, Kawamura T, Ando M, Endoh M, Tomino Y. A scoring system to predict renal outcome in IgA nephropathy: a nationwide 10-year prospective cohort study. Nephrol Dial Transplant. 2009;24:3068–74.

    Article  PubMed Central  PubMed  Google Scholar 

  8. Shen P, He L, Li Y, Wang Y, Chan M. Natural history and prognostic factors of IgA nephropathy presented with isolated microscopic hematuria in Chinese patients. Nephron Clin Pract. 2007;106:c157–61.

    Article  CAS  PubMed  Google Scholar 

  9. Szeto CC, Lai FM, To KF, Wong TY, Chow KM, Choi PC, et al. The natural history of immunoglobulin A nephropathy among patients with hematuria and minimal proteinuria. Am J Med. 2001;110:434–7.

    Article  CAS  PubMed  Google Scholar 

  10. Tatematsu M, Yasuda Y, Morita Y, Sakamoto I, Kurata K, Naruse T, et al. Complete remission within 2 years predicts a good prognosis after methylprednisolone pulse therapy in patients with IgA nephropathy. Clin Exp Nephrol. 2012;16:883–91.

    Article  CAS  PubMed  Google Scholar 

  11. Suzuki Y, Matsuzaki K, Suzuki H, Sakamoto N, Joh K, Kawamura T, et al. Proposal of remission criteria for IgA nephropathy. Clin Exp Nephrol. 2014;18:481–6.

    Article  CAS  PubMed  Google Scholar 

  12. Matsuo S. Clinical guides for immunoglobulin A (IgA) nephropathy in Japan, third version. Jpn J Nephrol. 2011;53:123–35 (Japanese).

  13. Kawamura T, Joh K, Okonogi H, Koike K, Utsunomiya Y, Miyazaki Y, et al. A histologic classification of IgA nephropathy for predicting long-term prognosis: emphasis on end-stage renal disease. J Nephrol. 2013;26:350–7.

  14. Matsuzaki K, Suzuki Y, Nakata J, Sakamoto N, Horikoshi S, Kawamura T, et al. Nationwide survey on current treatments for IgA nephropathy in Japan. Clin Exp Nephrol. 2013;17:827–33.

  15. Hotta O, Miyazaki M, Furuta T, Tomioka S, Chiba S, Horigome I, et al. Tonsillectomy and steroid pulse therapy significantly impact on clinical remission in patients with IgA nephropathy. Am J Kidney Dis. 2001;38:736–43.

  16. Matsuo S, Imai E, Horio M, Yasuda Y, Tomita K, Nitta K, et al. Revised equations for estimated GFR from serum creatinine in Japan. Am J Kidney Dis. 2009;53:982–92.

  17. Chauveau D, Droz D. Follow-up evaluation of the first patients with IgA nephropathy described at Necker Hospital. Contrib Nephrol. 1993;104:1–5.

  18. Miura N, Imai H, Kikuchi S, Hayashi S, Endoh M, Kawamura T, et al. Tonsillectomy and steroid pulse (TSP) therapy for patients with IgA nephropathy: a nationwide survey of TSP therapy in Japan and an analysis of the predictive factors for resistance to TSP therapy. Clin Exp Nephrol. 2009;13:460–6.

  19. Sakai H, Abe K, Kobayashi Y, Koyama A, Shigematsu H, Harada T, et al. Clinical guidelines of IgA nephropathy. Jpn J Nephrol. 1995;37:417–21 (Japanese).

  20. Suzuki K, Miura N, Imai H. Estimated glomerular filtration rate and daily amount of urinary protein predict the clinical remission rate of tonsillectomy plus steroid pulse therapy for IgA nephropathy. Clin Exp Nephrol. 2014;18:606–12.

  21. Syrjanen J, Mustonen J, Pasternack A. Hypertriglyceridaemia and hyperuricaemia are risk factors for progression of IgA nephropathy. Nephrol Dial Transplant. 2000;15:34–42.

  22. Ieiri N, Hotta O, Sato T, Taguma Y. Significance of the duration of nephropathy for achieving clinical remission in patients with IgA nephropathy treated by tonsillectomy and steroid pulse therapy. Clin Exp Nephrol. 2012;16:122–9.

  23. Wyatt RJ, Julian BA. IgA nephropathy. N Engl J Med. 2013;368:2402–14.

  24. Floege J, Feehally J. Treatment of IgA nephropathy and Henoch-Schonlein nephritis. Nat Rev Nephrol. 2013;9:320–7.

  25. Kawamura T, Yoshimura M, Miyazaki Y, Okamoto H, Kimura K, Hirano K, et al. A multicenter randomized controlled trial of tonsillectomy combined with steroid pulse therapy in patients with immunoglobulin A nephropathy. Nephrol Dial Transplant. 2014;29:1546–53.

  26. Hirano K, Kawamura T, Tsuboi N, Okonogi H, Miyazaki Y, Ikeda M, et al. The predictive value of attenuated proteinuria at 1 year after steroid therapy for renal survival in patients with IgA nephropathy. Clin Exp Nephrol. 2013;17:555–62.

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Acknowledgments

We thank Dr. Shigeki Iwasaki (Seirei Yokohama Hospital) and Dr. Susum Watanabe (Watanabe Clinic) for data collection.

Conflict of interest

The authors have declared that no conflict of interest exists.

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Authors and Affiliations

  1. Division of Nephrology, Department of Medicine, Showa University Fujigaoka Hospital, 1-30 Fujigaoka, Aoba-ku, Yokohama, 227-8501, Japan

    Yoshikuni Nagayama, Hiroki Nishiwaki, Takeshi Hasegawa, Daisuke Komukai, Eri Kawashima, Mamiko Takayasu, Hironori Tayama, Yoshihiko Inoue, Kiyoko Inui & Ashio Yoshimura

  2. Center for Innovative Research for Communities and Clinical Excellence, Fukushima Medical University, Fukushima, Japan

    Hiroki Nishiwaki & Takeshi Hasegawa

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  1. Yoshikuni Nagayama
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  2. Hiroki Nishiwaki
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Correspondence to Yoshikuni Nagayama.

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Nagayama, Y., Nishiwaki, H., Hasegawa, T. et al. Impact of the new risk stratification in the 2011 Japanese Society of Nephrology clinical guidelines for IgA nephropathy on incidence of early clinical remission with tonsillectomy plus steroid pulse therapy. Clin Exp Nephrol 19, 646–652 (2015). https://doi.org/10.1007/s10157-014-1052-4

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  • DOI: https://doi.org/10.1007/s10157-014-1052-4

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