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Impact of tonsillectomy combined with steroid pulse therapy on immunoglobulin A nephropathy depending on histological classification: a multicenter study

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Abstract

Background

In addition to corticosteroids and inhibition of the renin–angiotensin–aldosterone system, tonsillectomy with steroid pulse therapy (TSP) may have a beneficial impact on the clinical course of IgA nephropathy (IgAN). However, there is still much uncertainty regarding the indications for therapy, treatment protocol, and therapeutic options for IgAN.

Methods

In this multicenter retrospective cohort study, we enrolled 284 patients with biopsy-proven IgAN who received TSP or corticosteroid therapy or conservative therapy. The effects of TSP on clinical remission (CR) were evaluated after a median follow-up period of 4.1 years in relation to histological classifications.

Results

Among the 284 participants, 161 patients received TSP. During the observation time, 141 patients (49.6 %) achieved CR, with a median time to remission of 397 days. In multivariate Cox regression analyses, TSP had an impact on achieving CR in only the group with histological grade 3 defined as glomerulosclerosis, crescent formation or adhesion to Bowman’s capsule in 10–30 % of all biopsied glomeruli, or mild cellular infiltration in the interstitium (hazard ratio (HR) 4.29, 95 % confidence interval (95 %CI) 1.88–11.19, P < 0.001). TSP independently contributed to a higher incidence of CR, particularly in the patient group showing evident mesangial hypercellularity (HR 2.54, 95 %CI 1.38–5.08, P = 0.002).

Conclusions

TSP may have a beneficial effect on the clinical course in IgAN patients with mild to moderate glomerular and interstitial lesions, particularly with distinct mesangial cell proliferation.

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Acknowledgments

This study was presented in part at Kidney Week 2012 for the annual meeting of the American Society of Nephrology, November 2, 2012, in San Diego, CA, USA.

Conflict of interest

All of the authors declare that they have no competing interests.

Author information

Authors and Affiliations

  1. Second Department of Internal Medicine, University of Occupational and Environmental Health School of Medicine, Iseigaoka 1-1, Yahatanishi, Kitakyushu, Japan

    Tetsu Miyamoto, Nana Ishimatsu & Yutaka Otsuji

  2. Kidney Center, University of Occupational and Environmental Health School of Medicine, Kitakyushu, Japan

    Ryota Serino & Masahito Tamura

  3. Second Department of Internal Medicine, Nagasaki University School of Medicine, Nagasaki, Japan

    Tomoya Nishino & Tadashi Uramatsu

  4. Department of Endocrinology, Metabolism, Rheumatology and Nephrology, Faculty of Medicine, Oita University, Oita, Japan

    Takashi Nakata & Kaede Ishida

  5. Dialysis Division, University of Miyazaki Hospital, Miyazaki, Japan

    Yuji Sato

  6. First department of Internal Medicine, Miyazaki University School of Medicine, Miyazaki, Japan

    Hiroyuki Komatsu

  7. Blood Purification Center, Oita University Hospital, Oita, Japan

    Masanobu Miyazaki

  8. Miyazaki Naika Clinic, Nagasaki, Japan

    Tadashi Tomo

  9. Department of Hemovascular Medicine and Artificial Organs, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan

    Shouichi Fujimoto

Authors
  1. Tetsu Miyamoto
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  2. Tomoya Nishino
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  3. Takashi Nakata
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  4. Yuji Sato
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  5. Hiroyuki Komatsu
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  6. Tadashi Uramatsu
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  7. Nana Ishimatsu
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  8. Kaede Ishida
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  9. Ryota Serino
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  10. Yutaka Otsuji
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  11. Masanobu Miyazaki
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  12. Tadashi Tomo
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  13. Masahito Tamura
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  14. Shouichi Fujimoto
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Corresponding author

Correspondence to Tetsu Miyamoto.

Additional information

Steering committee for “IgA nephropathy from four universities (IgAN-4U)”, Japan.

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Miyamoto, T., Nishino, T., Nakata, T. et al. Impact of tonsillectomy combined with steroid pulse therapy on immunoglobulin A nephropathy depending on histological classification: a multicenter study. Clin Exp Nephrol 20, 50–57 (2016). https://doi.org/10.1007/s10157-015-1131-1

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  • DOI: https://doi.org/10.1007/s10157-015-1131-1

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