Kidney Week

Abstract: TH-PO1030

Effects of Tonsillectomy Monotherapy of Advanced-Stage IgA Nephropathy: A Case Series Study

Session Information

• Glomerular Diseases: Minimal Change Disease, FSGS, IgAN
  November 07, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Glomerular Diseases

• 1203 Glomerular Diseases: Clinical, Outcomes, and Trials

Authors

• Marumoto, Hirokazu, The Jikei University School of Medicine, Tokyo, Japan

Hirokazu Marumoto,

• Tsuboi, Nobuo, The Jikei University School of Medicine, Tokyo, Japan

Nobuo Tsuboi,

• Koike, Kentaro, The Jikei University School of Medicine, Tokyo, Japan

Kentaro Koike,

• Kawamura, Tetsuya, The Jikei University School of Medicine, Tokyo, Japan

Tetsuya Kawamura,

• Yokoo, Takashi, The Jikei University School of Medicine, Tokyo, Japan

Takashi Yokoo,

Background

Previous studies on Japanese patients with IgA nephropathy (IgAN) suggest the superiority of combination tonsillectomy and corticosteroid pulse therapy compared to corticosteroid pulse therapy alone; however, the efficacy of tonsillectomy monotherapy remains poorly understood.

Methods

Inclusion criteria consisted of patients with biopsy-proven IgAN with an estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73m² after 2 or more years of conventional therapeutic interventions, or those with an average urinary protein excretion > 500 mg/day for at least 6 months. Clinical characteristics, including renal function decline, were compared during the same observation periods before and after tonsillectomy.

Results

The patient cohort consisted of 5 males and 4 females, with an average age of 43 years. All patients had been treated with RAS inhibitors. Mean serum levels of creatinine were 1.32 mg/dL, with patients waiting an average of 161 months from initial diagnosis to tonsillectomy. Microscopic hematuria (1.10 vs. 0.20 grade, p = 0.003) and total urinary protein excretion (646 vs. 389 mg/day, p = 0.03) decreased significantly after tonsillectomy, relative to those before tonsillectomy. The slope of eGFR significantly improved after tonsillectomy versus before tonsillectomy (Figure; a mean value is shown as dashed line).

Conclusion

Tonsillectomy is an effective treatment option for advanced IgAN patients with persistent hematuria and proteinuria, independent of conventional therapeutic interventions.