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
Open Access
- 29 August 2012
- journal article
- research article
- Published by Springer Science and Business Media LLC in Clinical and Experimental Nephrology
- Vol. 17 (2), 218-224
- https://doi.org/10.1007/s10157-012-0679-2
Abstract
To clarify the therapeutic impact of tonsillectomy and combined therapies of tonsillectomy plus steroid on the long-term prognosis of immunoglobulin A nephropathy (IgAN). 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. The mean 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 N group (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. A combination therapy of tonsillectomy and steroid pulse had the most significant therapeutic impact compared to other therapies.Keywords
This publication has 12 references indexed in Scilit:
- Corticosteroid Effectiveness in IgA NephropathyJournal of the American Society of Nephrology, 2004
- A 10-year retrospective case-control study for IgA nephropathy after tonsillectomyInternational Congress Series, 2003
- Immunosuppressive agents for treating IgA nephropathyPublished by Wiley ,2003
- An “evidence-based” survey of therapeutic options for IgA nephropathy: assessment and criticismAmerican Journal of Kidney Diseases, 2003
- The efficacy of tonsillectomy on long-term renal survival in patients with IgA nephropathyKidney International, 2003
- Tonsillectomy and steroid pulse therapy significantly impact on clinical remission in patients with IgA nephropathyAmerican Journal of Kidney Diseases, 2001
- Corticosteroids in IgA nephropathy: a randomised controlled trialThe Lancet, 1999
- Natural history and risk factors for immunoglobulin a nephropathy in JapanAmerican Journal of Kidney Diseases, 1997
- Worldwide Perspective of IgA NephropathyAmerican Journal of Kidney Diseases, 1988
- Steroid therapy in IgA nephropathy: a prospective pilot study in moderate proteinuric cases.1986