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Abstract: PO1838

Long-Term Beneficial Effects of Tonsillectomy on Patients with Immunoglobulin A Nephropathy

Session Information

Category: Glomerular Diseases

  • 1203 Glomerular Diseases: Clinical, Outcomes, and Trials

Authors

  • Moriyama, Takahito, Tokyo Joshi Ika Daigaku, Shinjuku-ku, Tokyo, Japan
  • Karasawa, Kazunori, Tokyo Joshi Ika Daigaku, Shinjuku-ku, Tokyo, Japan
  • Miyabe, Yoei, Tokyo Joshi Ika Daigaku, Shinjuku-ku, Tokyo, Japan
  • Akiyama, Kenichi, Tokyo Joshi Ika Daigaku, Shinjuku-ku, Tokyo, Japan
  • Hanafusa, Norio, Tokyo Joshi Ika Daigaku, Shinjuku-ku, Tokyo, Japan
  • Nitta, Kosaku, Tokyo Joshi Ika Daigaku, Shinjuku-ku, Tokyo, Japan
Background

Tonsillectomy may treat immunoglobulin (Ig) A nephropathy (IgAN) by reducing the levels of galactose-deficient IgA1. Hence, we aimed to analyze the long-term effects of tonsillectomy as an initial treatment and a treatment at any time in their lives on patients with IgAN.

Methods

In this retrospective cohort analysis, 1147 patients with IgAN were grouped according to whether or not they had undergone tonsillectomy at any time in their lives (Study 1) or within 1 year after renal biopsy (Study 2). The patients who underwent tonsillectomy (T1) and who did not undergo tonsillectomy (T0) were propensity score matched, and the 20-year renal survival rates were evaluated until the serum creatinine level doubled (primary endpoint) and end-stage renal disease was reached (secondary endpoint).

Results

In both studies, the groups’ clinical data, histological data according to Oxford classification, and treatments such as immunosuppressants and inhibitors of renin-angiotensin systems were similar after propensity score matching (Study 1, n=179/each group (T1 vs. T0); median age: 31.0 vs. 30.0 years, p=0.53; mean arterial pressure: 90.0 vs. 88.0 mmHg, p=0.72; median eGFR: 76.1 and 79.1 mL/min/1.73m2, p=0.46; median proteinuria: 0.72 vs. 0.82 g/day, p=0.71) (Study 2: n=143/each group (T1 vs. T0); median age: 30.0 vs. 30.0 years, p=0.414; mean arterial pressure: 86.3 vs. 88.7 mmHg, p=0.56; median eGFR: 81.0 vs. 81.5 mL/min/1.73m2, p=0.98; median proteinuria: 0.77 vs. 0.62 g/day, p=0.48). In Study 1, the renal survival rates at the primary and secondary endpoints were significantly higher in T1 than in T0 (primary endpoint: 82.1 vs. 63.3%; p=0.002) (secondary endpoint: 98.1 vs. 76.3%; p= 0.002). In Study 2, the renal survival rate at the primary endpoint tended to be higher and the renal survival rate at the secondary endpoint was significantly higher in T1 compared with T0 (primary endpoint: 97.5 vs. 81.5%; p=0.063; secondary endpoint: 98.9 vs. 88.7%; p=0.04). Multivariate Cox regression analyses showed that immunosuppressants and tonsillectomy prevented disease progression (hazard ratio, 0.27; p=0.04). Complications associated with tonsillectomy occurred in 7.8% of the patients.

Conclusion

Among patients with IgAN, tonsillectomy at any time of life or soon after renal biopsy prevents disease progression, and it is relatively safe.