Is Tonsillectomy a Possible Treatment for IgA Nephropathy from Randomized Controlled Trial (RCT)?

Abstract

Tonsillectomy combined with steroid pulses has become one of the most widely used therapy protocols in the treatment of active IgA nephropathy (IgAN) in Japan. However, the role of tonsillectomy in the long-term prognosis of IgAN remains unclear, because it has not yet been tested in a randomized controlled trial (RCT). Thus, we conducted a multicenter RCT of tonsillectomy combined with steroid pulse therapy in patients with IgAN. Patients with biopsy-proven IgAN, moderate proteinuria ranging from 1.0 to 3.5 g/day, and serum creatinine of ≤1.5 mg/dL were randomly allocated to receive tonsillectomy combined with steroid pulses (Group A; n = 33) or steroid pulses alone (Group B; n = 39). The primary end points were the percentage decrease in urinary protein excretion from baseline and the frequency of the disappearance of proteinuria and/or hematuria. During 12 months from baseline, the percentage decrease in urinary protein excretion was significantly larger in Group A than that in Group B (P < 0.05). However, the frequency of the disappearance of proteinuria, hematuria, or both (clinical remission) at 12 months was not statistically different between the groups. Logistic regression analyses revealed the assigned treatment was a significant, independent factor contributing to the disappearance of proteinuria. The results indicate the antiproteinuric effect was significantly greater in combined therapy, whereas it has no beneficial effect over steroid pulses alone to attenuate hematuria and to increase the incidence of clinical remission. Nonetheless, the role of tonsillectomy on the renal functional outcome remains to be clarified.