Abstract

BackgroundDespite the abundant experience of tonsillectomy with steroid pulse therapy (TSP) for patients with immunoglobulin A (IgA) nephropathy, the therapeutic efficacy of TSP on renal prognosis remains controversial. The purpose of this study was to evaluate the efficacy of whether TSP effectively prevents chronic kidney disease (CKD) progression.MethodsThis was a single-center, retrospective observational study. A total of 149 patients were enrolled in the current study who were confirmed with IgA nephropathy by renal biopsy between February 2011 and August 2019. The impact of TSP on CKD progression was compared with conservative treatment during a follow-up period of 3 years.ResultsIn total, 110 patients received TSP and 39 patients received conservative treatment. There were no differences between the two groups in the initial CKD stages: 65.1% of patients had CKD G1-2, 32.2% had CKD G3, and 2.7% had CKD G4-5. The initial urine protein was 0.7 g/gCr, which was not different between the two groups. Kaplan-Meier analysis showed that patients with TSP had a significantly better renal prognosis than those in the conservative treatment group after one and a half years (p = 0.007). Multivariable analysis revealed that TSP had a significant impact on the prevention of CKD progression, with an adjusted odds ratio of 0.07 (95% confidence interval, 0.01-0.87; p=0.039). However, we could not confirm the predictive value of the Oxford Classification on TSP efficacy. Additionally, the initial urinary protein level was a risk factor for CKD progression.ConclusionsTSP was associated with a lower risk of CKD progression. In this regard, our study supports that TSP may be a reasonable treatment option for patients with IgA nephropathy. In the featured study, it needs to be elucidated which histopathological classifications benefit from TSP treatment.

Highlights

  • Immunoglobulin A (IgA) nephropathy was first described in 1968 by Berger [1] and is recognized as the most common primary glomerulonephritis worldwide [2].The pathogenesis of IgA nephropathy is uncertain; a plausible hypothesis is a multi-hit mechanism in which mesangial deposition of IgA1 may be the hallmark and a final common endpoint for pathogenesis

  • Kaplan-Meier analysis showed that patients with TSP had a significantly better renal prognosis than those in the conservative treatment group after one and a half years (p = 0.007)

  • Multivariable analysis revealed that TSP had a significant impact on the prevention of chronic kidney disease (CKD) progression, with an adjusted odds ratio of 0.07 (95% confidence interval, 0.01-0.87; p=0.039)

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Summary

Introduction

Immunoglobulin A (IgA) nephropathy was first described in 1968 by Berger [1] and is recognized as the most common primary glomerulonephritis worldwide [2].The pathogenesis of IgA nephropathy is uncertain; a plausible hypothesis is a multi-hit mechanism in which mesangial deposition of IgA1 may be the hallmark and a final common endpoint for pathogenesis. The synthesis of galactose-deficient IgA1 (Gd-IgA1) is disproportionally increased in patients with IgA nephropathy [3,4]. This aberrant Gd-IgA1 can form complexes with glycan-specific autoantibodies, resulting in pathogenic IgA1-containing circulating Gd-IgA1 immune complexes (Gd-IgA1-ICs) [5]. How to cite this article Aratani S, Matsunobu T, Shimizu A, et al (June 18, 2021) Tonsillectomy Combined With Steroid Pulse Therapy Prevents the Progression of Chronic Kidney Disease in Patients With Immunoglobulin A (IgA) Nephropathy in a Single Japanese Institution. Despite the abundant experience of tonsillectomy with steroid pulse therapy (TSP) for patients with immunoglobulin A (IgA) nephropathy, the therapeutic efficacy of TSP on renal prognosis remains controversial. The purpose of this study was to evaluate the efficacy of whether TSP effectively prevents chronic kidney disease (CKD) progression

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