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Abstract: PO1635

Enhanced Efficacy of Corticosteroid Therapy by Tonsillectomy in IgA Nephropathy

Session Information

Category: Glomerular Diseases

  • 1203 Glomerular Diseases: Clinical, Outcomes, and Trials

Authors

  • Hirano, Keita, Japanese Red Cross Ashikaga Hospital, Ashikaga, Tochigi, Japan
  • Kawamura, Tetsuya, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan
  • Koike, Kentaro, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan
  • Tsuboi, Nobuo, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan
  • Yokoo, Takashi, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan
  • Suzuki, Yusuke, Juntendo University Faculty of Medicine, Bunkyou-ku, Tokyo, Japan
Background

Efficacy of corticosteroid therapy in IgA nephropathy may vary among countries or races. Nowadays, the strategy to enhance efficacy of corticosteroid therapy is desired. In 2014, our randomized controlled trial demonstrated that corticosteroid therapy combined with tonsillectomy had superior anti-proteinuric effect than that of corticosteroid therapy alone (Nephrol Dial Transplant. 2014). However, the benefit of combining corticosteroid therapy with tonsillectomy for long-term renal survival was uncertain. Therefore, in a Japanese nationwide prospective cohort dataset, we aimed to evaluate whether the benefit of corticosteroid therapy may increase when it was combined with tonsillectomy, or not.

Methods

Patients were registered between April 1, 2005 and August 31, 2015 at 44 facilities throughout Japan. The primary outcome was a 50% increase in serum creatinine from baseline or dialysis induction. Two interventions were focused in the present study: corticosteroid with or without tonsillectomy. Survival analysis was adjusted with baseline clinicopathological parameters including eGFR, proteinuria, hematuria, RAS inhibitor use and MEST-C score in Oxford classification.

Results

Enrolled 991 patients showed 75.4 ml/min as mean eGFR and 0.58 g/day as median level of proteinuria. Among them, 634 (64.0%) and 425 (42.9%) patients received corticosteroid therapy and tonsillectomy, respectively. During the median follow up of 5.5 years, 87 patients (8.8%) reached primary outcome. Adjusted hazard ratio (HR) of corticosteroid therapy for primary outcome in patients with tonsillectomy was 3-fold favorable than that in those without tonsillectomy (HR 0.18, 95% confidence interval [CI] 0.06-0.65, versus HR 0.59, 95%CI 0.34-1.01; P value for interaction between corticosteroid therapy and tonsillectomy 0.060).

Conclusion

Enhanced efficacy of corticosteroid therapy by tonsillectomy in IgA nephropathy was confirmed in a Japanese nationwide prospective cohort.

Funding

  • Government Support – Non-U.S.