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Significance of tonsillectomy combined with steroid pulse therapy for IgA nephropathy with mild proteinuria

BACKGROUND: Medical intervention for patients with IgA nephropathy and mild proteinuria (<1.0 g/day) is controversial, and the effectiveness of tonsillectomy plus steroid pulse therapy (TSP) for such patients remains obscure. METHODS: Among 323 patients in our multicenter cohort study, 79 who had...

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Autores principales: Komatsu, Hiroyuki, Sato, Yuji, Miyamoto, Tetsu, Tamura, Masahito, Nakata, Takeshi, Tomo, Tadashi, Nishino, Tomoya, Miyazaki, Masanobu, Fujimoto, Shouichi
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer Japan 2015
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4756031/
https://www.ncbi.nlm.nih.gov/pubmed/26123429
http://dx.doi.org/10.1007/s10157-015-1138-7
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author Komatsu, Hiroyuki
Sato, Yuji
Miyamoto, Tetsu
Tamura, Masahito
Nakata, Takeshi
Tomo, Tadashi
Nishino, Tomoya
Miyazaki, Masanobu
Fujimoto, Shouichi
author_facet Komatsu, Hiroyuki
Sato, Yuji
Miyamoto, Tetsu
Tamura, Masahito
Nakata, Takeshi
Tomo, Tadashi
Nishino, Tomoya
Miyazaki, Masanobu
Fujimoto, Shouichi
author_sort Komatsu, Hiroyuki
collection PubMed
description BACKGROUND: Medical intervention for patients with IgA nephropathy and mild proteinuria (<1.0 g/day) is controversial, and the effectiveness of tonsillectomy plus steroid pulse therapy (TSP) for such patients remains obscure. METHODS: Among 323 patients in our multicenter cohort study, 79 who had mild proteinuria (0.4–1.0 g/day) at diagnosis were eligible to participate in this study. We compared the clinicopathological findings at diagnosis, a decline in renal function defined as a 50 or 100 % increase in serum creatinine (sCr) and clinical remission (CR) defined as the disappearance of hematuria and proteinuria (<0.3 g/day) among groups given TSP (n = 46), steroid therapy (ST) (n = 9), and non-ST (n = 24). Factors contributing to CR were also evaluated using multivariate analysis. RESULTS: Background factors at diagnosis including age, ratio (%) of patients with hypertension, sCr, proteinuria, and histological severity did not significantly differ among the groups. Only two patients each in the TSP (4.3 %) and non-ST (8.3 %) groups achieved a 50 % increase in sCr during a mean follow–up period of 4.7 years. At the final observation, 71.7, 44.4, and 41.7 % of patients in the TSP, ST, and non-ST groups, respectively, achieved CR (p = 0.032). Cox proportional hazards models revealed that TSP led to CR more effectively than non-TSP by a factor of about threefold (hazard ratio, 2.74; p = 0.008). CONCLUSION: TSP therapy has potential for inducing CR in patients with IgAN and mild proteinuria (<1.0 g/day).
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spelling pubmed-47560312016-02-26 Significance of tonsillectomy combined with steroid pulse therapy for IgA nephropathy with mild proteinuria Komatsu, Hiroyuki Sato, Yuji Miyamoto, Tetsu Tamura, Masahito Nakata, Takeshi Tomo, Tadashi Nishino, Tomoya Miyazaki, Masanobu Fujimoto, Shouichi Clin Exp Nephrol Original Article BACKGROUND: Medical intervention for patients with IgA nephropathy and mild proteinuria (<1.0 g/day) is controversial, and the effectiveness of tonsillectomy plus steroid pulse therapy (TSP) for such patients remains obscure. METHODS: Among 323 patients in our multicenter cohort study, 79 who had mild proteinuria (0.4–1.0 g/day) at diagnosis were eligible to participate in this study. We compared the clinicopathological findings at diagnosis, a decline in renal function defined as a 50 or 100 % increase in serum creatinine (sCr) and clinical remission (CR) defined as the disappearance of hematuria and proteinuria (<0.3 g/day) among groups given TSP (n = 46), steroid therapy (ST) (n = 9), and non-ST (n = 24). Factors contributing to CR were also evaluated using multivariate analysis. RESULTS: Background factors at diagnosis including age, ratio (%) of patients with hypertension, sCr, proteinuria, and histological severity did not significantly differ among the groups. Only two patients each in the TSP (4.3 %) and non-ST (8.3 %) groups achieved a 50 % increase in sCr during a mean follow–up period of 4.7 years. At the final observation, 71.7, 44.4, and 41.7 % of patients in the TSP, ST, and non-ST groups, respectively, achieved CR (p = 0.032). Cox proportional hazards models revealed that TSP led to CR more effectively than non-TSP by a factor of about threefold (hazard ratio, 2.74; p = 0.008). CONCLUSION: TSP therapy has potential for inducing CR in patients with IgAN and mild proteinuria (<1.0 g/day). Springer Japan 2015-06-30 2016 /pmc/articles/PMC4756031/ /pubmed/26123429 http://dx.doi.org/10.1007/s10157-015-1138-7 Text en © The Author(s) 2015 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
spellingShingle Original Article
Komatsu, Hiroyuki
Sato, Yuji
Miyamoto, Tetsu
Tamura, Masahito
Nakata, Takeshi
Tomo, Tadashi
Nishino, Tomoya
Miyazaki, Masanobu
Fujimoto, Shouichi
Significance of tonsillectomy combined with steroid pulse therapy for IgA nephropathy with mild proteinuria
title Significance of tonsillectomy combined with steroid pulse therapy for IgA nephropathy with mild proteinuria
title_full Significance of tonsillectomy combined with steroid pulse therapy for IgA nephropathy with mild proteinuria
title_fullStr Significance of tonsillectomy combined with steroid pulse therapy for IgA nephropathy with mild proteinuria
title_full_unstemmed Significance of tonsillectomy combined with steroid pulse therapy for IgA nephropathy with mild proteinuria
title_short Significance of tonsillectomy combined with steroid pulse therapy for IgA nephropathy with mild proteinuria
title_sort significance of tonsillectomy combined with steroid pulse therapy for iga nephropathy with mild proteinuria
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4756031/
https://www.ncbi.nlm.nih.gov/pubmed/26123429
http://dx.doi.org/10.1007/s10157-015-1138-7
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