Impact of tonsillectomy combined with steroid pulse therapy on immunoglobulin A nephropathy depending on histological classification: a multicenter study

Miyamoto, Tetsu; Nishino, Tomoya; Nakata, Takashi; Sato, Yuji; Komatsu, Hiroyuki; Uramatsu, Tadashi; Ishimatsu, Nana; Ishida, Kaede; Serino, Ryota; Miyazaki, Masanobu; Tomo, Tadashi; Tamura, Masahito; Fujimoto, Shouichi

doi:10.1007/s10157-015-1131-1

Cited by 8 publications

(2 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The Kidney Disease Improving Global Outcomes (KDIGO) Glomerulonephritis Work Group clinical practice guidelines for GN recommend that patients with persistent proteinuria ≥1 g/day, despite 3–6 months of optimized supportive care (including ACE-I or ARB's and blood pressure control) and a glomerular filtration rate (GFR) <50 ml/min per 1.73 m 2 receive a 6-month course of steroid therapy [6]. As an alternative treatment, tonsillectomy combined with steroid pulse (TSP) administration may be useful for inducing complete remission in patients with IgAN who have persistent proteinuria, although its long-term effectiveness remains uncertain [7, 8]. …”

Section: Introductionmentioning

confidence: 99%

A retrospective observational study of glucocorticoid-induced diabetes mellitus with IgA nephropathy treated with tonsillectomy plus methylprednisolone pulse therapy

et al. 2017

View full text Add to dashboard Cite

AimsTo evaluate the incidence of GC-DM among patients with immunoglobulin A nephropathy (IgAN) and to confirm the risk factors for the development of GC-DM.MethodsThe medical records of patients with IgAN newly treated with the protocol of tonsillectomy combined with steroid pulse therapy were reviewed. The primary outcome was the development of GC-DM within the hospitalization period and during one year of follow-up.ResultsDuring hospitalization, 19 of the 95 patients developed GC-DM (20.0%), and the patients with GC-DM were significantly older and had a higher rate of family history of diabetes and higher HbA1c levels. The prevalence of hypertension was higher and the eGFR was numerically lower in patients with GC-DM than in those without. Older age (≥45 years) and a family history of diabetes emerged as independent risk factors for the development of GC-DM (odds ratio [OR], 6.3 and 95% confidence interval [CI], 1.6–27.6; OR, 4.4 and 95% CI, 1.2–16.6, respectively). No patients were newly diagnosed with GC-DM during 1-year observation period at out-patient clinic.ConclusionsAmong the patients with IgAN, 20% developed GC-DM during the hospitalization period, confirming the family history of diabetes is clinically necessary before starting GC therapy.

show abstract

Section: Introductionmentioning

confidence: 99%

A retrospective observational study of glucocorticoid-induced diabetes mellitus with IgA nephropathy treated with tonsillectomy plus methylprednisolone pulse therapy

et al. 2017

View full text Add to dashboard Cite

show abstract

“…Very recently, Miyamoto et al reported that TSP had an impact on achieving clinical remission in only the group with histological grade 3 of the 2nd version clinical guideline for IgAN in Japan and M1 in their multicenter retrospective cohort study in 284 patients with IgAN who received TSP or corticosteroid therapy or conservative therapy [ 24 ]. In their study, the effect of TSP was compared to that of conservative therapy and they also found a significant superior effect of corticosteroid therapy including steroid pulses compared to that of conservative therapy in the group with histological grade 3.…”

Section: Discussionmentioning

confidence: 99%

Pathological sub-analysis of a multicenter randomized controlled trial of tonsillectomy combined with steroid pulse therapy versus steroid pulse monotherapy in patients with immunoglobulin A nephropathy

et al. 2015

View full text Add to dashboard Cite

BackgroundThe IgA nephropathy (IgAN) Study Group in Japan conducted a multicenter, randomized, controlled trial of tonsillectomy with steroid pulse therapy (TSP) versus steroid pulse monotherapy in patients with IgAN (UMIN Clinical Trial Registry Number; C000000384). The effects of therapies in relation to pathological severity were analyzed in this study.MethodsThe patients with IgAN, urinary protein 1.0–3.5 g/day, serum creatinine of 1.5 mg/dl or less were randomly assigned to receiving TSP (Group A) or steroid pulses alone (Group B). The primary endpoint was the disappearance of proteinuria and/or hematuria. Twenty-six biopsies in Group A and 33 in Group B were available. The histological grades (HG) according to the percentage of glomeruli with crescent or sclerosis and the Oxford classification were analyzed.ResultsThe patients in Group A had a 4.32- to 12.1-fold greater benefit of disappearance of proteinuria and 3.61- to 8.17-fold greater benefit of clinical remission (disappearance of proteinuria and hematuria) than those in Group B in patients with HG2–3, acute lesions (cellular or fibrocellular crescent) affecting more than 5 % of glomeruli, chronic lesions (fibrous crescents or sclerosis) affecting more than 20 % and S1. In contrast, odds ratios for disappearance of proteinuria or clinical remission in Group A to Group B were not significant in patients with HG 1, acute lesion in 5 % or less of glomeruli, chronic lesion in 20 % or less and S0. The disappearance of hematuria showed no relation to pathological severity.ConclusionTSP might be better employed according to the pathological severity.Electronic supplementary materialThe online version of this article (doi:10.1007/s10157-015-1159-2) contains supplementary material, which is available to authorized users.

show abstract

Tonsillectomy reduces recurrence of IgA nephropathy in mesangial hypercellularity type categorized by the Oxford classification

et al. 2015

View full text Add to dashboard Cite

BackgroundIn patients with IgA nephropathy (IgAN), recurrence after steroid pulse therapy is associated with reduced renal survival. However, the predictors of recurrence have not yet been clarified.MethodsAll patients who received 6-month steroid pulse therapy from 2004 to 2010 in our four affiliated hospitals and achieved a reduction of proteinuria to <0.4 g/day 1 year after treatment were retrospectively evaluated. The primary outcome was proteinuria ≥1.0 g/day during follow-up or additional antiproteinuric therapy. Two histological classifications were evaluated, the Oxford Classification with a split system and Japanese histological grades (HGs) with a lumped system.ResultsDuring a median follow-up of 3.4 years, 27 (26.7 %) of the 101 patients showed recurrence. Multivariate analysis showed that HG was the only significant predictor of recurrence, with HG 2+3+4 vs HG 1 having a hazard ratio of 7.38 (95 % confidence interval 1.52–133). Furthermore, in patients with mesangial hypercellularity according to the Oxford Classification, cumulative rate of recurrence-free survival was greater in patients with steroid therapy plus tonsillectomy compared with those who received steroid therapy alone (Log-rank test, P = 0.022). However, this association was not observed in patients without mesangial hypercellularity.ConclusionsHG is a novel predictor of recurrence after steroid pulse therapy in patients with IgAN. Moreover, the combination of steroid pulse therapy plus tonsillectomy may indicate a lower risk of recurrence in patients with mesangial hypercellularity, as defined by the Oxford Classification.Electronic supplementary materialThe online version of this article (doi:10.1007/s10157-015-1170-7) contains supplementary material, which is available to authorized users.

show abstract

Impact of tonsillectomy combined with steroid pulse therapy on immunoglobulin A nephropathy depending on histological classification: a multicenter study

Abstract: TSP may have a beneficial effect on the clinical course in IgAN patients with mild to moderate glomerular and interstitial lesions, particularly with distinct mesangial cell proliferation.

Cited by 8 publications

References 27 publications

A retrospective observational study of glucocorticoid-induced diabetes mellitus with IgA nephropathy treated with tonsillectomy plus methylprednisolone pulse therapy

A retrospective observational study of glucocorticoid-induced diabetes mellitus with IgA nephropathy treated with tonsillectomy plus methylprednisolone pulse therapy

Pathological sub-analysis of a multicenter randomized controlled trial of tonsillectomy combined with steroid pulse therapy versus steroid pulse monotherapy in patients with immunoglobulin A nephropathy

Tonsillectomy reduces recurrence of IgA nephropathy in mesangial hypercellularity type categorized by the Oxford classification

Contact Info

Product

Resources

About