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Multicenter Study
. 2024 Dec;28(12):1272-1281.
doi: 10.1007/s10157-024-02530-6. Epub 2024 Jul 2.

Effect of tonsillectomy combined with steroid pulse therapy upon IgA nephropathy depending on proteinuria status at diagnosis: a nationwide multicenter cohort study in Japan

Hiroyuki Komatsu  1 , Shouichi Fujimoto  2 , Yuji Sato  3 , Takashi Yasuda  4 , Yoshinari Yasuda  5 , Keiichi Matsuzaki  6 , Keita Hirano  7 , Tetsuya Kawamura  8 , Takashi Yokoo  8 , Yusuke Suzuki  9 , Shoichi Maruyama  10
Affiliations
Multicenter Study

Effect of tonsillectomy combined with steroid pulse therapy upon IgA nephropathy depending on proteinuria status at diagnosis: a nationwide multicenter cohort study in Japan

Hiroyuki Komatsu et al. Clin Exp Nephrol. 2024 Dec.

Abstract

Background: The effects of tonsillectomy combined with steroid pulse (TSP) therapy for IgA nephropathy (IgAN) are little known. Therefore, we examined the effects of TSP therapy on the kidney outcomes of IgAN in a large, nationwide cohort study in Japan.

Methods: Between 2002 and 2004, 632 IgAN patients with ≥ 0.5 g/day proteinuria at diagnosis were divided into three groups with mild (0.50-0.99 g/day; n = 264), moderate (1.00-1.99 g/day, n = 216), or severe (≥ 2.00 g/day; n = 153). Decline in kidney function and urinary remission were compared among the three groups after TSP therapy, corticosteroid (ST) therapy, or conservative therapy during a mean follow-up of 6.2 ± 3.3 years. 10.6% and 5.9% of patients in the ST and conservative therapy group underwent tonsillectomy.

Results: The rate of urinary remission at the final observation was significantly higher in the TSP therapy group than in the ST or conservative therapy groups (mild proteinuria: 64%, 43%, and 41%; moderate proteinuria: 51%, 45%, and 28%; severe proteinuria: 48%, 30%, and 22%, respectively). In contrast, the rate of a 50% increase in serum creatinine was lower in groups TSP therapy, than ST or conservative therapy (mild proteinuria: 2.1%, 10.1% and 16.7%; moderate proteinuria: 4.8%, 8.8% and 27.7%; severe proteinuria: 12.0%, 28.9% and 43.1%, respectively). In multivariate analysis, TSP therapy significantly prevented a 50% increase in serum creatinine levels compared with conservative therapy in groups with moderate and severe proteinuria (hazard ratio, 0.12 and 0.22, respectively).

Conclusion: TSP significantly increased the rate of proteinuria disappearance and urinary remission in IgAN patients with mild-to-moderate urinary protein levels. It may also reduce the decline in kidney function in patients with moderate-to-severe urinary protein levels.

Keywords: Glomerulonephritis; IgA nephropathy; Kidney outcome; Proteinuria; Steroid pulse therapy; Tonsillectomy.

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Conflict of interest statement

Declarations. Conflict of interest: All the authors have declared no competing interest. Ethical approval: All the procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee at which the studies were conducted and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Figures

Fig. 1
Fig. 1
Flowchart of the study design. UP: urinary protein
Fig. 2
Fig. 2
Comparison of urinary findings at final observation. TSP tonsillectomy combined with steroid pulse therapy, UP urinary protein. n.s. not significant, *p < 0.05
Fig. 3
Fig. 3
Comparison of prognosis (50% increase in sCr) among treatment modalities. Statistical analysis was performed using the log-rank test for Kaplan–Meier curves. TSP tonsillectomy combined with steroid pulse therapy, ST corticosteroid therapy, UP urinary protein, sCr serum creatinine
Fig. 4
Fig. 4
Comparison of prognosis (progression to ESKD) among treatment modalities. Statistical analysis was performed using the log-rank test for Kaplan–Meier curves. TSP tonsillectomy combined with steroid pulse therapy, ST corticosteroid therapy, UP urinary protein, ESKD end-stage kidney disease
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