Comparison of effective impact among tonsillectomy alone, tonsillectomy combined with oral steroid and with steroid pulse therapy on long-term outcome of immunoglobulin a nephropathy

Yoshihiro Yamamoto, Yoshiyuki Hiki, Shigeru Nakai, Koichiro Yamamoto, Kazuo Takahashi, Shigehisa Koide, Kazutaka Murakami, Makoto Tomita, Midori Hasegawa, Shiro Kawashima, Satoshi Sugiyama, Yukio Yuzawa

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Abstract

Background: To clarify the therapeutic impact of tonsillectomy and combined therapies of tonsillectomy plus steroid on the long-term prognosis of immunoglobulin A nephropathy (IgAN). Methods: A retrospective study was conducted on 208 patients with IgAN between 1986 and 2009. According to the strategies for treatments, patients were divided into four groups: tonsillectomy and steroid pulse (TSP, n = 47), tonsillectomy and oral steroid (TOS, n = 33), tonsillectomy alone (T, n = 56), and N group (no particular therapy, n = 72). Multivariate analysis based on the Cox's regression model was used to assess the relative risk of reaching the outcome of doubling creatinine based on the influence of baseline prognostic factors. Results: Themean observation periods were 53.8 months in the TSP group, 122.0 months in the TOS group, 102.9 months in the T group, and 84.6 months in the N group. During an observation period, serum creatinine levels doubled as follows: one in the TSP group (2.1 %), two in the TOS group (6.1 %), five in the T group (8.9 %), histological severity, and 22 in the Ngroup (30.6 %). The Cox's regression proportional hazard model showed that gender, age, histological activity, dialysis induction risk and therapy were associated with doubling creatinine levels. Hazard ratios (95 % CI) and (P value) in T, TOS, and TSP groups versus N were 0.314 (0.11-0.93, P = 0.037), 0.213 (0.04-1.10, P = 0.065), and 0.032 (0.00-0.28, P = 0.002), respectively. Conclusion: A combination therapy of tonsillectomy and steroid pulse had the most significant therapeutic impact compared to other therapies.

Original languageEnglish
Pages (from-to)218-224
Number of pages7
JournalClinical and Experimental Nephrology
Volume17
Issue number2
DOIs
Publication statusPublished - 01-01-2013

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All Science Journal Classification (ASJC) codes

  • Physiology
  • Nephrology
  • Physiology (medical)

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