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Impact of the number of steroid pulses in tonsillectomy combined with steroid pulse therapy: a nationwide retrospective study in Japan

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Abstract

Background

Steroid pulse therapy with tonsillectomy is known as a major treatment for IgA nephropathy (IgAN). However, its protocol was different among institutions and the effects of varying the number of steroid pulses remain unclear.

Methods

From a total of 1,174 IgAN patients in a multicenter retrospective cohort analysis in Japan, 195 patients were treated by tonsillectomy combined with corticosteroid. They were divided into four groups based on the number of administered steroid pulses from 0 to three (TSP0-3), and remission of urinary abnormalities and renal survival until 1.5-fold increase in serum creatinine level from baseline were analyzed among the four groups and between TSP1 and TSP3.

Results

Among the four groups, renal function was relatively good when the estimated glomerular filtration rate was approximately 80–90 mL/min/1.73m2 and proteinuria was relatively mild (< 1.0 g/gCre). The ratio of patients who developed renal dysfunction was < 5% in all groups, and the cumulative renal survival rate by Kaplan–Meier analysis was similar among groups (log-rank test, p = 0.37), despite varying clinical backgrounds and treatments. After adjustment of the background variables between TSP1 and TSP3, the remission rates of urinary abnormalities were similar and the renal survival rate also remained similar (66.8 vs. 85.4%, p = 0.45).

Conclusions

In patients with mild proteinuria and good renal function, the number of steroid pulses did not affect the renal outcome in steroid pulse therapy with tonsillectomy. The adaptation and protocols, such as the number of steroid pulses, should be determined for each IgAN patient’s background.

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Acknowledgements

We thank Editage (https://www.editage.jp) for editing this manuscript.

Funding

The main study [31] of this sub-analysis was supported in part by a Grant-in-Aid for Progressive Renal Diseases Research, Research on Rare and Intractable Disease, from the Ministry of Health, Labour and Welfare of Japan.

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Authors and Affiliations

  1. Department of Nephrology, Tokyo Women’s Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan

    Takahito Moriyama, Hiroshi Kataoka & Kosaku Nitta

  2. Division of Nephrology, Department of Internal Medicine, Ashikaga Red Cross Hospital, Ashikaga, Japan

    Keita Hirano

  3. Division of Nephrology and Hypertension, Department of Internal Medicine, Jikei University School of Medicine, Tokyo, Japan

    Keita Hirano, Kentaro Koike, Takashi Yokoo & Tetsuya Kawamura

  4. Department of Nephrology, Faculty of Medicine, Juntendo University, Tokyo, Japan

    Keiichi Matsuzaki & Yusuke Suzuki

  5. Kyoto University Health Service, Kyoto, Japan

    Keiichi Matsuzaki

  6. Department of Internal Medicine, Kichijoji Asahi Hospital, Kyoto, Japan

    Takashi Yasuda

  7. Department of Nephrology, Nagoya University, Nagoya, Japan

    Yoshinari Yasuda, Shoichi Maruyama & Seiichi Matsuo

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  1. Takahito Moriyama
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  2. Hiroshi Kataoka
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  13. Yusuke Suzuki
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Correspondence to Takahito Moriyama.

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Ethical approval: all procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee at which the studies were conducted (IRB approval number 2593) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Moriyama, T., Kataoka, H., Nitta, K. et al. Impact of the number of steroid pulses in tonsillectomy combined with steroid pulse therapy: a nationwide retrospective study in Japan. Clin Exp Nephrol 25, 19–27 (2021). https://doi.org/10.1007/s10157-020-01960-2

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  • DOI: https://doi.org/10.1007/s10157-020-01960-2

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