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Nephrol Dial Transplant. 2014 Aug;29(8):1546-53. doi: 10.1093/ndt/gfu020. Epub 2014 Mar 3.

A multicenter randomized controlled trial of tonsillectomy combined with steroid pulse therapy in patients with immunoglobulin A nephropathy.

Author information

1
Division of Kidney and Hypertension, Department of Internal Medicine, Jikei University School of Medicine, Tokyo, Japan.
2
Department of Internal Medicine, Kanazawa Medical Centre, Kanazawa, Japan.
3
Division of Kidney and Hypertension, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan.
4
Division of Clinical Epidemiology, Research Center for Medical Science, Jikei University School of Medicine, Tokyo, Japan.
5
Second Department of Internal Medicine, Nagasaki University Hospital of Medicine and Dentistry, Nagasaki, Japan.
6
Division of Nephrology, Department of Internal Medicine, Juntendo University School of Medicine, Tokyo, Japan.
7
Division of Nephrology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan.
8
Department of Internal Medicine, Chiba-East Hospital, Chiba, Japan.
9
Division of Kidney and Hypertension, Department of Internal Medicine, Saitama University Medical Centre, Saitama, Japan.
10
Department of Internal Medicine, National Hospital Organization, Osaka National Hospital, Osaka, Japan.
11
Department of Internal Medicine, Teine Keijinkai Hospital, Sapporo, Japan.
12
Division of Nephrology and Rheumatology, Department of Internal Medicine, Aichi Medical University School of Medicine, Nagakute, Aichi, Japan.
13
Department of Internal Medicine, Fuji City Central Hospital, Fuji, Japan.
14
Department of Internal Medicine, Iwate Prefectural Central Hospital, Morioka, Japan.
15
Department of Internal Medicine, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan.
16
Division of Nephrology, Department of Internal Medicine, Faculty of Medicine, University of Nagoya, Nagoya, Japan.

Abstract

BACKGROUND:

The study aim was, for the first time, to conduct a multicenter randomized controlled trial to evaluate the effect of tonsillectomy in patients with IgA nephropathy (IgAN).

METHODS:

Patients with biopsy-proven IgAN, proteinuria and low serum creatinine were randomly allocated to receive tonsillectomy combined with steroid pulses (Group A; n = 33) or steroid pulses alone (Group B; n = 39). The primary end points were urinary protein excretion and the disappearance of proteinuria and/or hematuria.

RESULTS:

During 12 months from baseline, the percentage decrease in urinary protein excretion was significantly larger in Group A than that in Group B (P < 0.05). However, the frequency of the disappearance of proteinuria, hematuria, or both (clinical remission) at 12 months was not statistically different between the groups. Logistic regression analyses revealed the assigned treatment was a significant, independent factor contributing to the disappearance of proteinuria (odds ratio 2.98, 95% CI 1.01-8.83, P = 0.049), but did not identify an independent factor in achieving the disappearance of hematuria or clinical remission.

CONCLUSIONS:

The results indicate tonsillectomy combined with steroid pulse therapy has no beneficial effect over steroid pulses alone to attenuate hematuria and to increase the incidence of clinical remission. Although the antiproteinuric effect was significantly greater in combined therapy, the difference was marginal, and its impact on the renal functional outcome remains to be clarified.

KEYWORDS:

clinical remission; estimated glomerular filtration rate; hematuria; proteinuria

PMID:
24596084
PMCID:
PMC4106640
DOI:
10.1093/ndt/gfu020
[Indexed for MEDLINE]
Free PMC Article

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