Long-Term Efficacy of Tonsillectomy in Chinese Patients with IgA Nephropathy

Abstract

Background: To investigate the clinical efficacy of tonsillectomy on long-term clinical remission and renal survival of immunoglobulin A nephropathy (IgAN) patients in China. Methods: We performed a 130-month retrospective case-control study of 112 patients with idiopathic biopsy-diagnosed IgAN from 1983 to 1999. Fifty-four patients underwent tonsillectomy and 58 patients did not. The clinical remission rate during follow-up and variables to predict clinical remission were estimated by χ² test and multivariate Cox regression analysis; renal survival was evaluated by Kaplan-Meier analysis. Results: Up to 2006, the follow-up period lasted 130 ± 50.3 months (60–276 months). The clinical remission rate was 46.3% in patients with tonsillectomy and 27.6% in those without tonsillectomy during follow-up. Multivariate analysis demonstrated that tonsillectomy was not an independent impact factor for renal clinical remission (p = 0.386). By Kaplan-Meier analysis, there was no significant difference in renal survival rate between patients with tonsillectomy and those without tonsillectomy (p = 0.059). Conclusion: The clinical remission rate in IgAN patients with tonsillectomy was higher than that in patients without tonsillectomy during follow-up. But within 130 months, it was difficult to find statistical difference in renal survival between IgAN patients with and without tonsillectomy.

Recent Therapeutic Strategies Improve Renal Outcome in Patients with IgA Nephropathy

“…Using retrospective lifetime and multivariate analysis, Xie et al [22] indicated that tonsillectomy significantly affected the renal survival rates of 118 patients over a long-term observational period (about 193 months). However, Chen et al [23] could not prove that tonsillectomy positively affected renal outcome using the same mode of analysis for 112 patients followed up for about 130 months. In contrast, the combination of steroid pulse therapy and tonsillectomy causes the remission of urinary abnormalities during a relatively early stage of IgAN [24].…”

Tonsillectomy in a European Cohort of 1,147 Patients with IgA Nephropathy

“…Tonsillectomy may lead to less frequent episodes of macroscopic hematuria following upper respiratory tract infections; however, the benefit in terms of reducing the decline in renal function over time was based on sporadic observations until the publication of a study in more than 100 Asian subjects showing a significant favourable effect of tonsillectomy in reducing end-stage renal disease (ESRD) over long-term follow-up [7]. These results were confirmed in other Japanese cohorts, mostly in association with corticosteroid therapy [8,9,10] and a meta-analysis suggested some benefits of tonsillar ablation in these patients [11]. A recent randomized, controlled trial in Japanese subjects, reported significantly lower proteinuria during follow-up in those who underwent tonsillectomy [12].…”

Tonsillectomy and Steroid Pulse Therapy for IgA Nephropathy

“…Rasche et al (1999) reported that there was no significant correlation between tonsillectomy and ESRD in 16 IgAN patients who underwent tonsillectomy and 39 patients who did not undergo tonsillectomy, and they concluded that tonsillectomy did not reduce the risk of renal failure during a mean follow-up period of 3.4 years. Chen et al (2007) reported that there was no significant difference in survival rate between 54 IgAN patients who underwent tonsillectomy and 58 IgAN patients who did not undergo tonsillectomy during a mean observation period of 130 months, although the proportion of cases that achieved a clinical remission was significantly higher in the tonsillectomy group. However, tonsillectomy was not an independent factor related to clinical remission according to the results of a Cox regression analysis.…”