Effect of Tonsillectomy Plus Steroid Pulse Therapy on Clinical Remission of IgA Nephropathy

Abstract

Background and objectives: Few well-designed investigations have examined how tonsillectomy plus steroid pulse therapy affects IgA nephropathy. A prospective, controlled study therefore was performed to compare the effects of combined therapy with those of steroid pulse alone in patients with IgA nephropathy.Design, setting, participants, & measurements: Fifty-five patients were followed up for 54.0 ؎ 21.2 mo. Thirty-five of them underwent tonsillectomy and steroid pulse therapy (group C), and 20 received steroid pulse monotherapy (group M). Both groups received methylprednisolone intravenously, followed by oral prednisolone (initial dosage 0.5 mg/kg per d) for 12 to 18 mo. Primary evaluation items were a 100% increase in serum creatinine from baseline levels or the disappearance of urinary protein (UP) and/or occult blood (UOB) indicating clinical remission.Results: At 24 mo after the initial treatment, the ratios of the UP and UOB disappearance were higher in group C than in group M, and the therapeutic effect persisted until the final observation. None of group C achieved a 100% increase in serum creatinine from the baseline level, whereas one patient in group M developed ESRD during the observation period. The histologic findings of repeated biopsy specimens from 18 patients revealed that mesangial proliferation and IgA deposition were significantly more reduced in group C than in group M. The Cox regression model showed that the combined therapy was approximately six-fold more effective in causing the disappearance of UP than steroid pulse monotherapy.Conclusion: Tonsillectomy combined with steroid pulse treatment can induce clinical remission in patients with IgA nephropathy.

Tonsillectomy with Methylprednisolone Pulse Therapy as Rescue Treatment for Steroid-Resistant IgA Nephropathy in Children

“…Hotta et al (2001) found that tonsillectomy combined with steroid pulse therapy reduced proteinuria and improved renal function in IgAN patients during a 5-year follow-up period, though clinical remission rates decreased in parallel with increase in histological score. In addition, Komatsu et al (2008) reported that tonsillectomy combined with steroid pulse treatment can induce clinical remission in patients with IgAN.…”

“…On the other hand, there have been some reports on the efficacy of tonsillectomy for IgAN in adults and children (Lozano et al 1985;Hotta et al 2001;Kawasaki et al 2006;Komatsu et al 2008). Hotta et al (2001) initially described tonsillectomy with methylprednisolone (MP) pulse therapy (tonsillectomy pulse therapy), which then became a popular approach to treating IgAN for several years in Japan.…”

Recurrent IgA nephropathy complicated with Crohn’s disease after renal transplantation

“…Tonsillectomy may affect upstream of the pathogenic mechanism by eliminating antigenic stimuli from the tonsillar mucosa. Some Japanese studies have recently reported that tonsillectomy in combination with steroid-pulse therapy can be a more effective therapy for IgA nephropathy than steroid-pulse monotherapy alone [8] or tonsillectomy alone [9,10]. Steroid-pulse therapy can affect downstream of the immunological mechanism by suppressing the abnormal immune response in bone marrow, leading to subsequent inflammation in renal glomeruli [11].…”

Tonsillectomy and Steroid Pulse Therapy for IgA Nephropathy

“…The clinical remission rate treated in the combination therapy group was 86.2% in stage 1 (UP < 0.5 g/day), 73.1% in stage 2 (UP = 0.5-1.0 g/ day), and 43.8% in stage 3 (1.0 g/day < UP and Cr >1.2 mg/ dL in female or > 1.4 mg/dl in male), as opposed to 71.4% in stage 2, and 11.1% in stage 3 in the steroid monotherapy group. Komatsu et al (2008) performed a prospective, controlled study to compare the effects of combination therapy and steroid pulse alone in IgAN patients. Fifty-five patients were followed up for 54 months, i.e., 35 who had undergone tonsillectomy and steroid pulse therapy and 20 who had received steroid pulse monotherapy.…”