Tetsu Miyamoto1, Tomoya Nishino2, Takashi Nakata3, Yuji Sato4, Hiroyuki Komatsu5, Tadashi Uramatsu2, Nana Ishimatsu6, Kaede Ishida3, Ryota Serino7, Yutaka Otsuji6, Masanobu Miyazaki8, Tadashi Tomo9, Masahito Tamura7, Shouichi Fujimoto10. 1. Second Department of Internal Medicine, University of Occupational and Environmental Health School of Medicine, Iseigaoka 1-1, Yahatanishi, Kitakyushu, Japan. tetsum@med.uoeh-u.ac.jp. 2. Second Department of Internal Medicine, Nagasaki University School of Medicine, Nagasaki, Japan. 3. Department of Endocrinology, Metabolism, Rheumatology and Nephrology, Faculty of Medicine, Oita University, Oita, Japan. 4. Dialysis Division, University of Miyazaki Hospital, Miyazaki, Japan. 5. First department of Internal Medicine, Miyazaki University School of Medicine, Miyazaki, Japan. 6. Second Department of Internal Medicine, University of Occupational and Environmental Health School of Medicine, Iseigaoka 1-1, Yahatanishi, Kitakyushu, Japan. 7. Kidney Center, University of Occupational and Environmental Health School of Medicine, Kitakyushu, Japan. 8. Blood Purification Center, Oita University Hospital, Oita, Japan. 9. Miyazaki Naika Clinic, Nagasaki, Japan. 10. Department of Hemovascular Medicine and Artificial Organs, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan.
Abstract
BACKGROUND: In addition to corticosteroids and inhibition of the renin-angiotensin-aldosterone system, tonsillectomy with steroid pulse therapy (TSP) may have a beneficial impact on the clinical course of IgA nephropathy (IgAN). However, there is still much uncertainty regarding the indications for therapy, treatment protocol, and therapeutic options for IgAN. METHODS: In this multicenter retrospective cohort study, we enrolled 284 patients with biopsy-proven IgAN who received TSP or corticosteroid therapy or conservative therapy. The effects of TSP on clinical remission (CR) were evaluated after a median follow-up period of 4.1 years in relation to histological classifications. RESULTS: Among the 284 participants, 161 patients received TSP. During the observation time, 141 patients (49.6%) achieved CR, with a median time to remission of 397 days. In multivariate Cox regression analyses, TSP had an impact on achieving CR in only the group with histological grade 3 defined as glomerulosclerosis, crescent formation or adhesion to Bowman's capsule in 10-30% of all biopsied glomeruli, or mild cellular infiltration in the interstitium (hazard ratio (HR) 4.29, 95% confidence interval (95%CI) 1.88-11.19, P < 0.001). TSP independently contributed to a higher incidence of CR, particularly in the patient group showing evident mesangial hypercellularity (HR 2.54, 95%CI 1.38-5.08, P = 0.002). CONCLUSIONS: 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.
BACKGROUND: In addition to corticosteroids and inhibition of the renin-angiotensin-aldosterone system, tonsillectomy with steroid pulse therapy (TSP) may have a beneficial impact on the clinical course of IgA nephropathy (IgAN). However, there is still much uncertainty regarding the indications for therapy, treatment protocol, and therapeutic options for IgAN. METHODS: In this multicenter retrospective cohort study, we enrolled 284 patients with biopsy-proven IgAN who received TSP or corticosteroid therapy or conservative therapy. The effects of TSP on clinical remission (CR) were evaluated after a median follow-up period of 4.1 years in relation to histological classifications. RESULTS: Among the 284 participants, 161 patients received TSP. During the observation time, 141 patients (49.6%) achieved CR, with a median time to remission of 397 days. In multivariate Cox regression analyses, TSP had an impact on achieving CR in only the group with histological grade 3 defined as glomerulosclerosis, crescent formation or adhesion to Bowman's capsule in 10-30% of all biopsied glomeruli, or mild cellular infiltration in the interstitium (hazard ratio (HR) 4.29, 95% confidence interval (95%CI) 1.88-11.19, P < 0.001). TSP independently contributed to a higher incidence of CR, particularly in the patient group showing evident mesangial hypercellularity (HR 2.54, 95%CI 1.38-5.08, P = 0.002). CONCLUSIONS: TSP may have a beneficial effect on the clinical course in IgANpatients with mild to moderate glomerular and interstitial lesions, particularly with distinct mesangial cell proliferation.
Entities:
Keywords:
IgA nephropathy; Pathological classification; Tonsillectomy
Authors: Philip Kam-Tao Li; Chi Bon Leung; Kai Ming Chow; Yuk Lun Cheng; Samuel Ka-Shun Fung; Siu Ka Mak; Anthony Wing-Chung Tang; Teresa Yuk-Hwa Wong; Chun Yu Yung; Jonathan Chee-Unn Yung; Alex Wai-Yin Yu; Cheuk Chun Szeto Journal: Am J Kidney Dis Date: 2006-05 Impact factor: 8.860