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Efficacy of tonsillectomy pulse therapy versus multiple-drug therapy for IgA nephropathy

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Abstract

We evaluated the efficacy of tonsillectomy plus pulse prednisolone, warfarin, and dipyridamole including methylprednisolone pulse (tonsillectomy plus pulse therapy), versus prednisolone, warfarin, and dipyridamole including mizoribine (PWDM) for the treatment diffuse IgA nephropathy (IgAN) in children. The patients were randomly assigned to be treated by tonsillectomy plus pulse therapy for 2 years (Group A, n=16) or PWDM for 2 years (Group B, n=16). The clinical features and pathological findings in both groups were analyzed prospectively. The mean urinary protein excretion after 6 months of treatment in both groups had decreased significantly compared with pre-therapy. The activity index (AI) in both groups was lower at the time of the second biopsy than at the time of the first biopsy. The chronicity index (CI) in Groups A and B did not differ between the first and second biopsy. At the latest follow-up examination none (0%) of the patients in either group had renal insufficiency. None of the patients in Group A, but six patients in Group B experienced an acute exacerbation of IgAN as a result of tonsillitis (P<0.05). In conclusion, although there was no untreated control group in this study, the results suggested that tonsillectomy plus pulse therapy is as effective as PWDM in ameliorating proteinuria and histological severity in IgAN patients and in preventing acute exacerbation of IgAN by tonsillitis.

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References

  1. Berger J, Hinglais N (1968) Les depots intercapillaireis d’IgA-IgG. J Urol Nephrol 74:694–695

    CAS  Google Scholar 

  2. Hogg RJ, Silva F, Wyatt R, Reisch JS, Argyle JC, Savino DA (1994) Prognostic indicators in children with IgA nephropathy—report of the Southwest Pediatric Nephrology Study Group A. Pediatr Nephrol 8:15–20

    Article  CAS  Google Scholar 

  3. McEnery PT, McAdams AJ, West CD (1972) Glomerular morphology, natural history and treatment of children with IgA-IgG mesangial nephropathy. In: Kincaid-Smith P, Mathew TH, Becker EL (eds) Glomerulonephritis: natural history and treatment. Wiley, New York, pp 305–320

    Google Scholar 

  4. Andreoli SP, Bergstein JM (1989) Treatment of severe Iga nephropathy in children. Pediatr Nephrol 3:248–253

    Article  CAS  Google Scholar 

  5. Yoshikawa N, Ito H, Ninomiya M, the Japanese pediatric IgA nephropathy treatment study group (1999) A controlled trial of combined therapy for newly diagnosed severe childhood IgA nephropathy. J Am Soc Nephrol 10:101–109

    CAS  PubMed  Google Scholar 

  6. Welch TR, Fryer C, Quinlan M, Witte DP, Quinlan M (1992) Double-blind, controlled trial of short-term prednisone therapy in immunoglobulin A glomerulonephritis. J Pediatr 121:474–477

    Article  CAS  Google Scholar 

  7. Kawasaki Y, Hosoya M, Suzuki J, Onishi N, Takahashi A, Isome M, Nozawa R, Suzuki H (2004) Efficacy of multidrug therapy combined with mizoribine in children with diffuse IgA nephropathy. Am J Nephrol 24:576–581

    Article  CAS  Google Scholar 

  8. Kawasaki Y, Suzuki J, Sakai N, Etoh S, Murai H, Nozawa R, Suzuki, H (2004) Efficacy of prednisolone and mizoribine therapy for disuse IgA nephropathy. Am J Nephrol 24:147–153

    Article  CAS  Google Scholar 

  9. Hotta O, Miyazaki M, Furuta T, Tomioka S, Chiba S, Horigome I, Abe K, Taguma Y (2001) Tonsillectomy and steroid pulse therapy significantly impact on clinical remission in patients with IgA nephropathy. Am J Kidney Dis 38:736–743

    Article  CAS  Google Scholar 

  10. Lozano L, Garcia-Hoya R, Egido J, Blasco R, Sancho J (1985) Tonsillectomy decreases the synthesis of polymeric IgA by blood lymphocytes and clinical activity in patients with IgA nephropathy. Proc EDTA-ERA 22:33–37

    Google Scholar 

  11. Maeda Y, Terazawa K, Kawakami S, Ogura Y, Sugiyama N (1988) Clinical and immunological study of IgA nephropathy before and after tonsillectomy. Acta Otolaryngol Suppl 508:29–35

    Google Scholar 

  12. Waldo FB, Alexander R, Wyatt RJ, Kohaut EC (1989) Alternate-day prednisone therapy in children with IgA-associated nephritis. Am J Kidney Dis 13:55–60

    Article  CAS  Google Scholar 

  13. Xie Y, Nishi S, Ueno M, Imai N, Sakatsume M, Narita I, Suzuki Y, Akazawa K, Shimada H, Arakawa M, Gejyo F (2003) The efficacy of tonsillectomy on long-term renal survival in patients with IgA nephropathy. Kidney Int 63:1861–1867

    Article  Google Scholar 

  14. Wyatt RJ, Hogg RJ (2001) Evidence-based assessment of treatment options for children with IgA nephropathies. Pediatr Nephrol 16:156–167

    Article  CAS  Google Scholar 

  15. Tomino Y, Sakai H, Endoh M, Miura M, Suga T, Kaneshige H, Nomoto Y (1983) Cross-reactivity of IgA antibodies between renal mesangial areas and nuclei of tonsillar cell in patients with IgA nephropathy. Clin Exp Immunol 51:605–610

    CAS  PubMed  PubMed Central  Google Scholar 

  16. Suzuki S, Nakatomi Y, Sato H, Tsukada H, Arakawa M (1994) Haemophilus parainfluenzae antigen and antibody in renal biopsy samples and serum of patients with IgA nephropathy. Lancet 343:12–16

    Article  CAS  Google Scholar 

  17. Suzuki S, Fujieda S, Sunaga H, Yamamoto C, Kimura H, Gejyo F (2000) Synthesis of immunoglobulins against Haemophilus parainfluenzae by tonsillar lymphocytes from patients with IgA nephropathy. Nephrol Dial Transplant 15:619–624

    Article  CAS  Google Scholar 

  18. Hotta O (2004) Tonsillectomy combined with steroid pulse therapy: a curative therapy for IgA nephropathy. Acta Otolaryngol 555:43–48

    Article  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Pediatrics, Fukushima Medical University School of Medicine, 1 Hikariga-oka, Fukushima City, Fukushima, 960-1295, Japan

    Yukihiko Kawasaki, Kei Takano, Kazuhide Suyama, Masato Isome, Hitoshi Suzuki & Mitsuaki Hosoya

  2. Department of Pediatrics, Kureha General Hospital, 1 Hikariga-oka, Fukushima City, Fukushima, 960-1295, Japan

    Hideki Suzuki

  3. Department of Pediatrics, Hoshi General Hospital, 1 Hikariga-oka, Fukushima City, Fukushima, 960-1295, Japan

    Hiroko Sakuma

  4. Department of Pediatrics, Takeda General Hospital, 1 Hikariga-oka, Fukushima City, Fukushima, 960-1295, Japan

    Tomoo Fujiki

Authors
  1. Yukihiko Kawasaki
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  2. Kei Takano
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  3. Kazuhide Suyama
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  4. Masato Isome
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  5. Hideki Suzuki
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  6. Hiroko Sakuma
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  7. Tomoo Fujiki
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  8. Hitoshi Suzuki
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  9. Mitsuaki Hosoya
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Correspondence to Yukihiko Kawasaki.

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Kawasaki, Y., Takano, K., Suyama, K. et al. Efficacy of tonsillectomy pulse therapy versus multiple-drug therapy for IgA nephropathy. Pediatr Nephrol 21, 1701–1706 (2006). https://doi.org/10.1007/s00467-006-0272-6

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  • DOI: https://doi.org/10.1007/s00467-006-0272-6

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