Skip to main content

Advertisement

SpringerLink
Log in

Comparison of methods of steroid administration combined with tonsillectomy for IgA nephropathy patients

  • Original Article
  • Published:
Clinical and Experimental Nephrology Aims and scope Submit manuscript

Abstract

Background

IgA nephropathy (IgAN) is a chronic glomerular disease that causes end-stage renal disease in 20–40 % of patients within 20 years. The efficacy of tonsillectomy combined with steroid pulse (SP) administration (TSP) for clinical remission of IgAN has been reported. Particularly in Japan, TSP has been performed widely. However, the optimum method for steroid administration in TSP has not been established.

Methods

We retrospectively compared clinical remission in IgAN patients treated with tonsillectomy combined with two different steroid administration methods: (1) three courses of SP therapy and oral prednisolone administered on alternate days (group 3A; n = 25); and (2) one course of SP therapy and oral prednisolone administered on consecutive days (group 1C; n = 22).

Results

There was no significant difference in the clinical remission rates between the two groups at 12 (48.0 vs. 40.9 %, P = 0.77) and 24 months after starting treatment (68.0 vs. 72.7 %, P = 0.76) and at the final observation (76.0 vs. 81.8 %, P = 0.73). The mean period from starting treatment to remission of hematuria in group 3A was significantly shorter than that in group 1C (5.7 ± 4.4 vs. 9.9 ± 5.9 months, P = 0.03). Dyslipidemic patients treated for the first time with statin after the SP therapy were more present in group 3A at 24 months (P = 0.02).

Conclusions

In IgAN patients, treatment of group 3A may be effective for inducing rapid remission of hematuria. Further studies are needed to establish an appropriate protocol for TSP.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

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

    Article  CAS  PubMed  Google Scholar 

  2. Koyama A, Igarashi M, Kobayashi M. Natural history and risk factors for immunoglobulin A nephropathy in Japan. Research Group on Progressive Renal Diseases. Am J Kidney Dis. 1997;29:526–32.

    Article  CAS  PubMed  Google Scholar 

  3. Moriyama T, Tanaka K, Iwasaki C, et al. Prognosis in IgA nephropathy: 30-year analysis of 1012 patients at a single center in Japan. PLoS One. 2014;9:e91756.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Pozzi C, Bolasco PG, Fogazzi GB, et al. Corticosteroids in IgA nephropathy: a randomised controlled trial. Lancet. 1999;353:883–7.

    Article  CAS  PubMed  Google Scholar 

  5. Pozzi C, Andrulli S, Del Vecchio L, et al. Corticosteroid effectiveness in IgA nephropathy: long-term results of a randomized, controlled trial. J Am Soc Nephrol. 2004;15:157–63.

    Article  CAS  PubMed  Google Scholar 

  6. Xie Y, Nishi S, Ueno M, et al. The efficacy of tonsillectomy on long-term renal survival in patients with IgA nephropathy. Kidney Int. 2003;63:1861–7.

    Article  PubMed  Google Scholar 

  7. Hotta O, Miyazaki M, Furuta T, 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.

    Article  CAS  PubMed  Google Scholar 

  8. Miura N, Imai H, Kikuchi S, 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.

    Article  CAS  PubMed  Google Scholar 

  9. Komatsu H, Fujimoto S, Hara S, Sato Y, Yamada K, Kitamura K. Effect of tonsillectomy plus steroid pulse therapy on clinical remission of IgA nephropathy: a controlled study. Clin J Am Soc Nephrol. 2008;3:1301–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Ochi A, Moriyama T, Takei T, Uchida K, Nitta K. Comparison between steroid pulse therapy alone and in combination with tonsillectomy for IgA nephropathy. Int Urol Nephrol. 2013;45:469–76.

    Article  CAS  PubMed  Google Scholar 

  11. Nakagawa N, Kabara M, Matsuki M, et al. Retrospective comparison of the efficacy of tonsillectomy with and without steroid-pulse therapy in IgA nephropathy patients. Intern Med. 2012;51:1323–8.

    Article  PubMed  Google Scholar 

  12. Kawamura T, Yoshimura M, Miyazaki Y, 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.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Matsuzaki K, Suzuki Y, Nakata J, et al. Nationwide survey on current treatments for IgA nephropathy in Japan. Clin Exp Nephrol. 2013;17:827–33.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Kamei D, Moriyama T, Takei T, Wakai S, Nitta K. Comparison between consecutive and intermittent steroid pulse therapy combined with tonsillectomy for clinical remission of IgA nephropathy. Clin Exp Nephrol. 2014;18:320–8.

    Article  CAS  PubMed  Google Scholar 

  15. Cattran DC, Coppo R, Cook HT, et al. The Oxford classification of IgA nephropathy: rationale, clinicopathological correlations, and classification. Kidney Int. 2009;76:534–45.

    Article  PubMed  Google Scholar 

  16. Kawamura T, Joh K, Okonogi H, 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.

    Article  CAS  PubMed  Google Scholar 

  17. Clinical guides for immunoglobulin A (IgA) nephropathy in Japan, third version. Nihon Jinzo Gakkai Shi. 2011;53:123–35.

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

    Article  CAS  PubMed  Google Scholar 

  19. Suzuki Y, Matsuzaki K, Suzuki H, et al. Proposal of remission criteria for IgA nephropathy. Clin Exp Nephrol. 2013;18:481–6.

    Article  PubMed  Google Scholar 

  20. Hotta O. Use of corticosteroids, other immunosuppressive therapies, and tonsillectomy in the treatment of IgA nephropathy. Semin Nephrol. 2004;24:244–55.

    Article  CAS  PubMed  Google Scholar 

  21. Moreno JA, Yuste C, Gutiérrez E, et al. Haematuria as a risk factor for chronic kidney disease progression in glomerular diseases: a review. Pediatr Nephrol. 2016;31:523–33.

    Article  PubMed  Google Scholar 

  22. Gutiérrez E, González E, Hernández E, et al. Factors that determine an incomplete recovery of renal function in macrohematuria-induced acute renal failure of IgA nephropathy. Clin J Am Soc Nephrol. 2007;2:51–7.

    Article  PubMed  Google Scholar 

  23. 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  PubMed Central  Google Scholar 

  24. Yuste C, Rubio-Navarro A, Barraca D, et al. Haematuria increases progression of advanced proteinuric kidney disease. PLoS One. 2015;10:e0128575.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Suzuki Y, Matsuzaki K, Suzuki H, et al. Serum levels of galactose-deficient immunoglobulin (Ig) A1 and related immune complex are associated with disease activity of IgA nephropathy. Clin Exp Nephrol. 2014;18:770–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Suzuki H, Kiryluk K, Novak J, et al. The pathophysiology of IgA nephropathy. J Am Soc Nephrol. 2011;22:1795–803.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  27. Tanaka K, Moriyama T, Iwasaki C, Takei T, Nitta K. Effect of hematuria on the outcome of IgA nephropathy with mild proteinuria. Clin Exp Nephrol. 2015;19:815–21.

    Article  CAS  PubMed  Google Scholar 

  28. Coppo R. Is a legacy effect possible in IgA nephropathy? Nephrol Dial Transplant. 2013;28:1657–62.

    Article  CAS  PubMed  Google Scholar 

  29. Szeto CC, Lai FM, To KF, 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 

  30. Kawaguchi T, Ieiri N, Yamazaki S, et al. Clinical effectiveness of steroid pulse therapy combined with tonsillectomy in patients with immunoglobulin A nephropathy presenting glomerular haematuria and minimal proteinuria. Nephrology (Carlton). 2010;15:116–23.

    Article  CAS  PubMed  Google Scholar 

  31. Barratt J, Feehally J. Treatment of IgA nephropathy. Kidney Int. 2006;69:1934–8.

    Article  CAS  PubMed  Google Scholar 

  32. Tatematsu M, Yasuda Y, Morita Y, 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 

Download references

Author information

Authors and Affiliations

  1. Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuoku, Niigata, Niigata, 951-8510, Japan

    Hirofumi Watanabe, Shin Goto, Suguru Yamamoto, Yoshikatsu Kaneko & Ichiei Narita

  2. Department of Nephrology and Rheumatology, Niigata City General Hospital, Niigata, Japan

    Daisuke Kondo

  3. Department of Nephrology, Nagaoka Chuo General Hospital, Nagaoka, Japan

    Takuma Takata

  4. Department of Internal Medicine, Nagaoka Red Cross Hospital, Nagaoka, Japan

    Hajime Yamazaki

  5. Department of Clinical Nutrition Science, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan

    Michihiro Hosojima

  6. Department of Nephrology, Tachikawa General Hospital, Nagaoka, Japan

    Ryuji Aoyagi

Authors
  1. Hirofumi Watanabe
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Shin Goto
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Daisuke Kondo
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Takuma Takata
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Hajime Yamazaki
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Michihiro Hosojima
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Suguru Yamamoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Yoshikatsu Kaneko
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Ryuji Aoyagi
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Ichiei Narita
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Shin Goto.

Ethics declarations

Conflict of interest

The authors have declared that no conflict of interest exists.

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Watanabe, H., Goto, S., Kondo, D. et al. Comparison of methods of steroid administration combined with tonsillectomy for IgA nephropathy patients. Clin Exp Nephrol 21, 257–265 (2017). https://doi.org/10.1007/s10157-016-1282-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10157-016-1282-8

Keywords

Search

Navigation