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Comparison of oral steroids with tonsillectomy plus steroid pulse therapy in patients with IgA nephropathy

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Abstract

Background

Treatment of IgA nephropathy (IgAN) in Japan has recently changed, from oral prednisolone (oPSL) to tonsillectomy plus steroid pulse (TSP) therapy. However, a few studies have compared their efficacy and safety.

Methods

IgAN patients diagnosed in our institution between 1991 and 2013, treated with TSP or oPSL, aged ≥16 years, with ≥1 g/day proteinuria, and estimated glomerular filtration rate (eGFR) ≥30 ml/min/1.73 m2, and no other renal disease were selected. Baseline clinical and histological findings, clinical outcomes, and adverse events were compared. Clinical remission (CR) was defined as <0.3 g/day proteinuria and <5 urinary red blood cells per high-powered field.

Results

Sixty-six patients were identified; after propensity score adjustment, 26 patients were selected in each group. CR rates were significantly higher at 12 (30.8 % vs. 3.9 %), 36 (47.3 % vs. 7.9 %), and 72 (57.8 % vs. 20.1 %) months (p < 0.01), and the renal survival rate, defined as the development of a 25 % reduction from baseline eGFR, was significantly higher at 12 (96.2 % vs. 69.2 %), 36 (96.2 % vs. 61.5 %), and 72 (96.2 % vs. 41.0 %) months in the TSP than the oPSL group (p < 0.001). Multivariate analysis showed that TSP was the only independent factor associated with CR (hazard ratio, 3.58; 95 % confidence interval, 1.32–10.91, p = 0.01). The number of patients with adverse events was significant lower in TSP group than in oPSL group (11.5 % vs. 34.6 %, p = 0.04).

Conclusions

CR rates are higher; protection of renal function and prevention from adverse events were superior with TSP than with oPSL in patients with IgAN and moderate-to-severe proteinuria.

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Authors and Affiliations

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

    Yoshie Hoshino, Takahito Moriyama, Keiko Uchida, Ken Tsuchiya & Kosaku Nitta

Authors
  1. Yoshie Hoshino
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  2. Takahito Moriyama
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  3. Keiko Uchida
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  4. Ken Tsuchiya
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  5. Kosaku Nitta
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Correspondence to Takahito Moriyama.

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The authors report no disclosures or conflicts of interest.

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 #3738) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

“Informed consent for renal biopsy was obtained from all individual participants included in the study.”

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Hoshino, Y., Moriyama, T., Uchida, K. et al. Comparison of oral steroids with tonsillectomy plus steroid pulse therapy in patients with IgA nephropathy. Clin Exp Nephrol 21, 617–623 (2017). https://doi.org/10.1007/s10157-016-1324-2

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  • DOI: https://doi.org/10.1007/s10157-016-1324-2

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