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The impact of tonsillectomy combined with steroid pulse therapy in patients with advanced IgA nephropathy and impaired renal function

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Abstract

Background

Preventing progression to end-stage renal disease (ESRD) in advanced IgA nephropathy (IgAN) patients with impaired renal function remains challenging. We analyzed the efficacy of tonsillectomy combined with steroid pulse therapy (TSP).

Methods

In this retrospective analysis, IgAN patients with proteinuria > 0.5 g/day and estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m2 were divided into three groups: patients treated with TSP (TSP group; n = 23), oral prednisolone (oPSL group; n = 41), and conservative therapy (CONS group, n = 51). We analyzed the clinical and histological backgrounds, remission of urinary findings, and renal survival rate to a 25% decline in eGFR from baseline, and incidence of ESRD.

Results

There were significant differences in the patients’ backgrounds among the groups. Therefore, we adjusted the background using propensity score marching between TSP group and oPSL or CONS group. The 5-year remission rate of hematuria was significantly higher in the TSP group than in the oPSL group, and that of both hematuria and proteinuria was significantly higher in the TSP group than in the CONS group. The 10-year renal survival rate was significantly higher in the TSP group than in the oPSL and CONS groups. In a multivariate Cox regression analysis, TSP was found to be an independent factor for the 25% decline in eGFR in entire cohort. The adverse effect frequency in the TSP group was similar to the CONS group.

Conclusions

TSP can effectively induce remission of urinary abnormality and improve the prognosis without frequent adverse effects in IgAN patients with impaired renal function.

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Acknowledgements

We thank Clare Cox, Ph.D., and Jodi Smith, Ph.D. from Edanz Group (www.edanzediting.com/ac) for editing a draft of this manuscript.

This retrospective cohort study was conducted in accordance with the guidelines of the Declaration of Helsinki and was approved by the Medical Ethics Committee of Tokyo Women’s Medical University (reference #4289). We received oral consent from all patients to perform renal biopsy and we provided the patients with the opportunity to Opt Out of this study.

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Authors and Affiliations

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

    Saeko Kumon, Takahito Moriyama, Takahiro Kamiyama, Kazunori Karasawa & Kosaku Nitta

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  1. Saeko Kumon
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  2. Takahito Moriyama
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  3. Takahiro Kamiyama
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  4. Kazunori Karasawa
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  5. Kosaku Nitta
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Correspondence to Takahito Moriyama.

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Supplemental Materials 1

. Comparison of clinical and histological findings between TSP and SP group. The mean Age and the median U-Prot were significant lower in the TSP group compared with the SP group (age: 37.7 vs. 55.4 years, p < 0.01, U-Prot: 1.42 vs. 2.31 g/day, p < 0.05). Supplemental Materials 2. Comparison of the 5-year cumulative remission rate of urinary findings and 10-year renal survival rate between TSP and SP groups. a The remission rate of hematuria was 90.6% in the TSP group and 66.7% in the SP group (p = 0.41). b The remission rate of proteinuria was 89.1% in the TSP group and 46.5% in the SP group (p = 0.92). c The rate of clinical remission was 59.1% in the TSP group and 33.3% in the SP group (p = 0.30). d The survival rate until a 25% decline in eGFR from baseline was 80.4% in the TSP group and 90.9% in the SP group (p = 0.87). e The survival rate until progression to ESRD was 100% in the both groups. (PPTX 73 kb)

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Kumon, S., Moriyama, T., Kamiyama, T. et al. The impact of tonsillectomy combined with steroid pulse therapy in patients with advanced IgA nephropathy and impaired renal function. Clin Exp Nephrol 24, 295–306 (2020). https://doi.org/10.1007/s10157-019-01828-0

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  • DOI: https://doi.org/10.1007/s10157-019-01828-0

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