Abstract
Background
To clarify the long-term efficacy of multiple-drugs combination therapy (PWDM) and tonsillectomy pulse therapy (TPT) for pediatric IgA nephropathy (IgAN), we retrospectively evaluated the clinical and laboratory findings as well as the prognosis for IgAN patients treated with each treatment at long-term follow-up.
Methods
We collected data on 61 children who had been diagnosed with severe IgAN. The children were retrospectively divided into two groups. Group 1 consisted of 44 severe IgAN children treated with PWDM, and Group 2 consisted of 17 severe IgAN children treated with TPT. The clinical features, pathological findings, and prognosis were analyzed for both groups.
Results
The mean urinary protein excretion, serum creatinine, IgA levels, MESTCG scores, and percentage of glomeruli showing crescents in both groups at the second renal biopsy were lower than those at the first renal biopsy. At the time of the second biopsy, the IgA level in Group 2 was lower than that in Group 1; however, there were no significant differences in the mean urinary protein excretion, frequency of hematuria, serum albumin, creatinine, or e-GFR between the two groups. At the most recent follow-up, there were no significant differences in prognosis between the groups.
Conclusions
Our study suggested that PWDM and TPT are effective in ameliorating urinary abnormalities and improving the long-term outcome of pediatric IgAN.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Wyatt RJ, Julian BA. IgA nephropathy. N Engl J Med. 2013;368:2402–14.
Nozawa R, Suzuki J, Isome M, Kawasaki Y, Suzuki S, Suzuki H. Clinicopathological features and the prognosis of IgA nephropathy in Japanese children on long-term observation. Clin Nephrol. 2005;64:171–9.
Yoshikawa N, Ito H, Ninomiya M. the Japanese pediatric IgA nephropathy treatment study group. A controlled trial of combined therapy for newly diagnosed severe childhood IgA nephropathy. J Am Soc Nephrol. 1999;10:101–9.
Welch TR, Fryer C, Quinlan M, Witte DP, Quinlan M. Double-blind, controlled trial of short-term prednisone therapy in immunoglobulin A glomerulonephritis. J Pediatr. 1999;121:474–7.
Kamei K, Nakanishi K, Ito S, et al. Long-term results of a randomized controlled trial in childhood IgA nephropathy. Clin J Am Soc Nephrol. 2011;6:1301–7
Kawasaki Y, Suzuki J, Sakai N, Etoh S, Murai H, Nozawa R, et al. Efficacy of prednisolone and mizoribine therapy for disuse IgA nephropathy. Am J Nephrol. 2004;24:147–53.
Kawasaki Y, Suyama K, Miyazaki K, Kanno S, Ono A, Suzuki Y, et al. Resistance factors for the treatment of immunoglobulin A nephropathy with diffuse mesangial proliferation. Nephrology(Carlton). 2014;19:384–91.
Hotta O, Miyazaki M, Furuta T, et al. Tonsillectomy and steroid pulse therapy significantly impact on clinical remission in patients with IgA nephropathy. Am J Kidney Dis 2001; 38:736–43.
Lozano L, Garcia-Hoya R, Egido J, Blasco R, Sancho J. Tonsillectomy decreases the synthesis of polymeric IgA by blood lymphocytes and clinical activity in patients with IgA nephropathy. Proc EDTA-ERA 1985; 22:33–7.
Kawasaki Y, Takano K, Suyama K, Isome M, Suzuki H, Sakuma H, et al. Efficacy of tonsillectomy plus therapy versus multiple-drug therapy for IgA nephropathy. Pediatr Nephrol. 2006;21:1701–6.
Liu LL, Wang LN, Jiang Y, et al. Tonsillectomy for IgA nephropathy: a meta-analysis. Am J Kidney Dis. 2015;65:80–7.
Wang Y, Chen J, Wang Y, Chen Y, Wang L, Lv Y. A meta-analysis of the clinical remission rate and long-term efficacy of tonsillectomy in patients with IgA nephropathy. Nephrol Dial Transpl. 2011;26:1923–31.
Uemura O, Honda M, Matsuyama T, et al. Is the new Schwartz equation derived from serum creatinine and body length suitable for evaluation of renal function in Japanese children? Eur J Pediatr. 2012;171:1401–4.
Nakanishi K, Yoshikawa N. Immunoglobulin A, Nephropathy. Section 5. Glomerular disease. In: Avner ED, Harmon WE, Niaudet P, Yoshikawa N, editors. Pediatric nephrology, vol 2, 6th ed. Springer, Berlin; 2009. p. 757–82.
Haas M, Verhave JC, Liu ZH, et al. A multicenter study of the predictive value of crescents in IgA nephropathy. J Am Soc Nephrol. 2017;28:691–701.
Fujinaga S, Ohtomo Y, Hirano D, et al. Low-dose pulse methylprednisolone followed by short-term combination therapy and tonsillectomy for childhood IgA nephropathy. Pediatr Nephrol. 2010;25:563–4.
Meng H, Ohtake H, Ishida A, Ohta N, Kakehata S, Yamakawa M. IgA production and tonsillar focal infection in IgA nephropathy. J Clin Exp Hematol 2012;52:161–70.
Giannakakis K, Feriozzi S, Perez M, Faraggiana T, Muda AO. Aberrantly glycosylated IgA1 in glomerular immune deposits of IgA nephropathy. J Am Soc Nephrol. 2007;18:3139–46.
Feehally J, Coppo R, Troyano S, et al. Tonsillectomy in a European Cohort of 1,147 patients with IgA nephropathy. Nephron. 2016;132:15–24.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
No authors have any conflicts of interest or financial support related to the present study.
Ethical standards
The study was carried out under the auspices of the Committee for Human Experiments at the Fukushima Medical University School (Institutional Review Board approval number 2254).
Informed consent
Informed consent was obtained from all patients or their parents.
About this article
Cite this article
Kawasaki, Y., Maeda, R., Kanno, S. et al. Comparison of long-term follow-up outcomes between multiple-drugs combination therapy and tonsillectomy pulse therapy for pediatric IgA nephropathy. Clin Exp Nephrol 22, 917–923 (2018). https://doi.org/10.1007/s10157-017-1515-5
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10157-017-1515-5