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Effect of tonsillectomy with steroid pulse therapy on circulating tumor necrosis factor receptors 1 and 2 in IgA nephropathy

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Abstract

Background

High circulating levels of soluble tumor necrosis factor receptors (TNFRs: TNFR1, TNFR2) predict renal function decline in a variety of kidney diseases. Tonsillectomy with steroid pulse (TSP) therapy has been reported as a remission induction therapy in IgA nephropathy (IgAN), mainly in Japan. However, little is known about whether TNFR levels change after TSP therapy in patients with IgAN.

Methods

Two hundred twenty-three patients with IgAN were stratified according to the estimated glomerular filtration rate (eGFR): Group I (eGFR ≥ 60 mL/min/1.73 m2, n = 172) and Group II (eGFR < 60 mL/min/1.73 m2, n = 51). We measured serum TNFR levels with immunoassay in all patients at the time of renal biopsy, and also in patients whose samples just before the first (after tonsillectomy) (n = 34) and/or the third steroid pulse therapy (n = 77) were available.

Results

The TNFR levels were significantly higher in Group II than in Group I. A significant negative correlation was observed between TNFR levels and eGFR at baseline (TNFRs: r > −0.50). In multivariate logistic regression analysis, both TNFRs were associated with renal function decline, independent of age and uric acid levels. Proteinuria and hematuria remarkably improved after TSP therapy, as expected. In comparison with baseline TNFR levels, the levels of TNFR2, but not TNFR1, decreased significantly just before the third steroid pulse therapy, although both levels did not change after tonsillectomy.

Conclusions

The TNFR2 level did not change after tonsillectomy alone but decreased significantly after steroid pulse therapy in patients with IgAN.

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Author information

Authors and Affiliations

  1. Division of Nephrology, Department of Internal Medicine, Juntendo University Faculty of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, Japan

    Maki Murakoshi, Tomohito Gohda, Yuji Sonoda, Hitoshi Suzuki, Yasuhiko Tomino, Satoshi Horikoshi & Yusuke Suzuki

Authors
  1. Maki Murakoshi
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  2. Tomohito Gohda
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  3. Yuji Sonoda
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  4. Hitoshi Suzuki
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  5. Yasuhiko Tomino
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  6. Satoshi Horikoshi
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  7. Yusuke Suzuki
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Corresponding author

Correspondence to Tomohito Gohda.

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Conflict of interest

The authors have declared that no conflict of interest exists.

Ethical approval

All procedures performed were in accordance with the ethical standards of the Institutional Review Board of the Juntendo University Faculty of Medicine at which the study was conducted (IRB approval number 2013058) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Supplementary material 1 (DOCX 20 KB)

10157_2017_1408_MOESM2_ESM.pptx

Supplementary Figure 1. TNFR concentrations before and after tonsillectomy in 34 patients with IgA nephropathy. There were no significant differences in TNFR1 and TNFR2 levels between before and after tonsillectomy (p = 0.30, 0.40, respectively). (PPTX 48 KB)

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Murakoshi, M., Gohda, T., Sonoda, Y. et al. Effect of tonsillectomy with steroid pulse therapy on circulating tumor necrosis factor receptors 1 and 2 in IgA nephropathy. Clin Exp Nephrol 21, 1068–1074 (2017). https://doi.org/10.1007/s10157-017-1408-7

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  • DOI: https://doi.org/10.1007/s10157-017-1408-7

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