Long-term efficacy of tonsillectomy as a treatment in patients with IgA nephropathy: a meta-analysis

Duan, Jiayu; Li, Dongwei; Duan, Guangcai; Liu, Zhangzuo

doi:10.1007/s11255-016-1432-7

Cited by 31 publications

(31 citation statements)

References 35 publications

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“…We estimated that enrolling 107 patients would provide 80% power to detect a difference in tonsillectomy category with a 2-sided significance level of .05 in the analysis of the primary outcome, assuming an expected result of a 0.33 HR. 30 For all models, we graphically verified the proportionality of hazards for the Cox proportional hazards assumption using log plots. For missing values, we used the multivariate imputation method (eTable 3 in the Supplement ).…”

Section: Methodsmentioning

confidence: 99%

Association Between Tonsillectomy and Outcomes in Patients With Immunoglobulin A Nephropathy

et al. 2019

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Key Points Question Is there an association between undergoing tonsillectomy within 1 year of the initial diagnosis of IgA nephropathy and the subsequent renal outcome? Findings In this cohort study of 1065 Japanese patients with IgA nephropathy diagnosed between 2002 and 2004, the matched patients who underwent tonsillectomy had a lower risk of renal events than those who did not undergo the procedure. Meaning Tonsillectomy may improve renal survival rates in patients with IgA nephropathy independent of conventional therapy using renin-angiotensin system inhibitors and corticosteroids.

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Section: Methodsmentioning

confidence: 99%

Association Between Tonsillectomy and Outcomes in Patients With Immunoglobulin A Nephropathy

et al. 2019

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“…The efficacy of tonsillectomy for IgAN has been clinically shown by a recent randomized controlled trials, 52 and it has also been published as a recommended treatment in IgAN clinical practice guidelines. 4 Recently, scientific evidence supporting the use of tonsillectomy has gradually accumulated, and this treatment is being developed not only in Asia 53,54 but also in Europe and the United States. 30,55 We hope that many additional researchers will publish new evidence linking the tonsils and kidneys in the future.…”

Section: Discussionmentioning

confidence: 99%

Recent advances in the immunological understanding of association between tonsil and immunoglobulin A nephropathy as a tonsil‐induced autoimmune/inflammatory syndrome

Harabuchi

Takahara

2019

Immunity Inflam & Disease

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Introduction Immunoglobulin A nephropathy (IgAN) is the most common form of primary glomerulonephritis worldwide. It is well known that upper respiratory tract infections, particularly acute tonsillitis, often worsen IgAN. Recent many clinical studies clearly show that tonsillectomy with steroid pulse therapy is the effective treatments for IgAN patients. Recently, the immunological evidence of association between tonsil and IgAN has been reported. Methods In this review, the mechanism underlying the onset of IgAN, as a tonsil‐induced autoimmune/inflammatory syndrome (TIAS), is outlined with the main focus on the authors' research results. Results In the tonsils of patients with IgAN, hyperimmune response to the unmethylated deoxycytidyl‐deoxyguanosine oligodeoxynucleotides (CpG‐ODN) take place, resulting in hyperproduction of interferon‐γ. The hyperproduction is followed by both overproduction of mutated IgA via B‐cell activating factor (BAFF)/a proliferation‐inducing ligand (APRIL)‐mediated pathways and overexpression of T‐cell receptor Vβ6, CXCR3, and CX3CR1 on tonsillar T cells. These IgA and T cells home to the kidney via the systemic circulation, resulting in nephritis of IgAN. Conclusions Scientific evidence supporting the use of tonsillectomy has gradually accumulated. We hope that many additional researchers will publish new evidence linking the tonsils and kidneys in the future.

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“…Nakata and his colleague found that serum GdIgA1 levels decreased more than half after tonsillectomy, which indicated that the palatine tonsils are probably major sites of GdIgA1-producing cells [18]. A meta-analysis suggested that TSP is helpful in inducing clinical remission and inhibiting the development of ESRD in IgA nephropathy patients [19].…”

Section: Discussionmentioning

confidence: 99%

Efficacy and Safety of Agents in IgA Nephropathy: An Update Network Meta-Analysis

Yang

Wang

Xie

et al. 2018

Kidney Blood Press Res

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Background/Aims: The present network meta-analysis of randomized controlled trials (RCTs) was to explore the efficacy and safety of different pharmacologic interventions in IgA nephropathy with proteinuria more than 0.75 g/d. Methods: We systematically searched the Cochrane Library, Embase, and PubMed database for studies compared the rate of clinical remission and/or serious adverse events in IgA nephropathy patients with proteinuria (> 0.75 g/d) up to August 1, 2018. We ranked the comparative effects of all drugs against placebo on the surface under the cumulative ranking area (SUCRA) probabilities. Results: There were 29 RCTs comprising 2517 participants included for the comparisons of 9 interventions. The rank of the most effective treatments for inducing clinical remission was renin-angiotensin system inhibitors (RASi) in combination with steroid, tonsillectomy combined with steroid pulse therapy, and azathioprine plus RASi with SUCRA of 82.9%, 80.5%, and 67.6%, respectively. RASi in combination with steroid (SUCRA 3.9%) was the most effective in prevention of end-stage renal disease or doubling serum creatinine, followed by RASi monotherapy (SUCRA 38.4%) and azathioprine combined with steroid (SUCRA 49.0%). As for the occurrence of serious adverse events, azathioprine combined with RASi (SUCRA 88.0%) and steroid plus RASi (SUCRA 74.6%) showed the first and second highest incidence of adverse events, respectively. Conclusion: RASi combined with steroid demonstrated the most effective therapeutic approach for IgA nephropathy patients in terms of reducing proteinuria and stabilizing renal function.

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Long-term efficacy of tonsillectomy as a treatment in patients with IgA nephropathy: a meta-analysis

Abstract: Long-term efficacy of tonsillectomy indicates that this treatment is helpful in inducing clinical remission and inhibiting development of end-stage renal disease in patients with IgAN and should be considered for addition into standard clinical treatment.

Cited by 31 publications

References 35 publications

Association Between Tonsillectomy and Outcomes in Patients With Immunoglobulin A Nephropathy

Association Between Tonsillectomy and Outcomes in Patients With Immunoglobulin A Nephropathy

Recent advances in the immunological understanding of association between tonsil and immunoglobulin A nephropathy as a tonsil‐induced autoimmune/inflammatory syndrome

Efficacy and Safety of Agents in IgA Nephropathy: An Update Network Meta-Analysis

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