Abstract: SA-PO277

The Beneficial Effect of Tonsillectomy Combined with Steroid Pulse Therapy on IgA Nephropathy Patients with Impaired Renal Function

Session Information

Category: Glomerular

  • 1005 Clinical Glomerular Disorders

Authors

  • Kumon, Saeko, Tokyo Women's Medical University Hospital, Tokyo, Japan
  • Moriyama, Takahito, Tokyo Women's Medical University, Tokyo, Japan
  • Kamiyama, Takahiro, Tokyo Women''s Medical University, Tokyo-to, Japan
  • Nakano, Marie, Tokyo Women's Medical University Hospital, Tokyo, Japan
  • Nitta, Kosaku, Tokyo Women's Medical University, Tokyo, Japan
Background


Tonsilectomy combined with steroid pulse therapy (TSP) has been reported to have beneficial effects on IgA nephropathy (IgAN), and has become a major treatment in Japan. However, it is still controversial whether TSP is effective for IgAN with impaired renal function or not, though the impaired renal function at the time of renal biopsy is still recognized as one of the severe risk factor of IgAN. Therefore, we analyzed the efficacy of TSP in IgAN with impaired renal function.

Methods


In this retrospective analysis, IgAN patients who was diagnosed from January 2006 to May 2015 in our institution, age≧16, >0.5g/day proteinuria and estimated glomerular filtration rate(eGFR) < 60 ml/min/1.73m2 were divided into the two groups : the patients treated with TSP (TSP group; n=25) and the patients treated with oral prednisolone (oPSL group; n=41). We compared the clinical and histological findings at base line, renal survival rate until 25 % decline of eGFR from base line and progression to end stage renal disease (ESRD), and clinical remission(CR) rate defined as <0.3 g/day proteinuria and <5 urinary red blood cells per high-powered field (HPF) between both groups.

Results

There was no significant difference in clinical and histological findings between both groups (mean eGFR: 44.6 vs. 44.3 mL/min/1.73m2; p=0.875, median proteinuria: 1.78 vs. 1.37 g/g creatinine; p=0.247, distribution of the amount of hematuria: 2, 11, 1, 13 vs. 3, 13, 5, 4 (<5, 5-20, 21-50, >51/HPF; p=0.097). The renal survival rate, until 25 % reduction from baseline eGFR, and until progression to ESRD was significantly higher in TSP than oPSL group (79.7% vs. 40.4%/9 years; p=0.009, 100.0% vs. 65.4%/9years; p=0.0495, respectively). The remission rate of hematuria was significantly higher in TSP than oPSL group (92.9% vs. 47.1%/4.5years; p<0.0001), though the remission rate of proteinuria was similar between both groups. TSP was the only independent factor to decrease hematuria according to the multivariate Cox regression analysis (OR: 3.10, 95% CI: 1.40-6.77, p=0.006).

Conclusion


TSP was effective for remission of hematuria and long term renal prognosis in IgAN patients with impaired renal function.