Significance of tonsillectomy combined with steroid pulse therapy for IgA nephropathy with mild proteinuria.
Clin Exp Nephrol
; 20(1): 94-102, 2016 Feb.
Article
in En
| MEDLINE
| ID: mdl-26123429
ABSTRACT
BACKGROUND:
Medical intervention for patients with IgA nephropathy and mild proteinuria (<1.0 g/day) is controversial, and the effectiveness of tonsillectomy plus steroid pulse therapy (TSP) for such patients remains obscure.METHODS:
Among 323 patients in our multicenter cohort study, 79 who had mild proteinuria (0.4-1.0 g/day) at diagnosis were eligible to participate in this study. We compared the clinicopathological findings at diagnosis, a decline in renal function defined as a 50 or 100% increase in serum creatinine (sCr) and clinical remission (CR) defined as the disappearance of hematuria and proteinuria (<0.3 g/day) among groups given TSP (n = 46), steroid therapy (ST) (n = 9), and non-ST (n = 24). Factors contributing to CR were also evaluated using multivariate analysis.RESULTS:
Background factors at diagnosis including age, ratio (%) of patients with hypertension, sCr, proteinuria, and histological severity did not significantly differ among the groups. Only two patients each in the TSP (4.3%) and non-ST (8.3%) groups achieved a 50% increase in sCr during a mean follow-up period of 4.7 years. At the final observation, 71.7, 44.4, and 41.7% of patients in the TSP, ST, and non-ST groups, respectively, achieved CR (p = 0.032). Cox proportional hazards models revealed that TSP led to CR more effectively than non-TSP by a factor of about threefold (hazard ratio, 2.74; p = 0.008).CONCLUSION:
TSP therapy has potential for inducing CR in patients with IgAN and mild proteinuria (<1.0 g/day).Key words
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Proteinuria
/
Steroids
/
Tonsillectomy
/
Glomerulonephritis, IGA
Type of study:
Diagnostic_studies
/
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Country/Region as subject:
Asia
Language:
En
Journal:
Clin Exp Nephrol
Journal subject:
NEFROLOGIA
Year:
2016
Type:
Article
Affiliation country:
Japan