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Kidney Week

Abstract: TH-PO613

Clinical Courses in IgA Vasculitis with Nephritis Underwent Tonsillectomy

Session Information

Category: Glomerular Diseases

  • 1402 Glomerular Diseases: Clinical, Outcomes, and Trials

Authors

  • Kubo, Eisuke, Tokyo Jikeikai Ika Daigaku, Minato-ku, Tokyo, Japan
  • Haruhara, Kotaro, Tokyo Jikeikai Ika Daigaku, Minato-ku, Tokyo, Japan
  • Marumoto, Hirokazu, Tokyo Jikeikai Ika Daigaku, Minato-ku, Tokyo, Japan
  • Sasaki, Takaya, Tokyo Jikeikai Ika Daigaku, Minato-ku, Tokyo, Japan
  • Okabe, Masahiro, Tokyo Jikeikai Ika Daigaku, Minato-ku, Tokyo, Japan
  • Yokote, Shinya, Tokyo Jikeikai Ika Daigaku, Minato-ku, Tokyo, Japan
  • Ueda, Hiroyuki, Tokyo Jikeikai Ika Daigaku, Minato-ku, Tokyo, Japan
  • Tsuboi, Nobuo, Tokyo Jikeikai Ika Daigaku, Minato-ku, Tokyo, Japan
  • Yokoo, Takashi, Tokyo Jikeikai Ika Daigaku, Minato-ku, Tokyo, Japan
Background

Adult-onset IgA vasculitis (IgAV) frequently presents with kidney involvement and is often associated with unfavorable clinical courses. There is no established treatment in IgAV with nephritis (IgAVN) other than renin-angiotensin-aldosterone inhibitors and corticosteroids. Although tonsillectomy is one of the treatment options in primary IgA nephropathy, the efficacy of tonsillectomy in IgAVN has not been determined to date.

Methods

Adult patients with biopsy-proven IgAVN who received tonsillectomy at 6 hospitals in Japan from 2015 to 2022 were recruited. Changes in hematuria, time-averaged urine protein-to-creatinine ratio (UPCR), estimated glomerular filtration rate (eGFR), and serum IgA were evaluated before and after tonsillectomy. Hematuria remission and proteinuria remission were defined as three consecutive urinary RBC<5/HPF and UPCR<0.3g/g for at least 6 months, respectively.

Results

A total of 12 patients with IgAVN who underwent tonsillectomy were identified. The median observation periods before and after tonsillectomy were 20.7 months and 48.6 months, respectively. Corticosteroids were prescribed before and after the tonsillectomy in 5 (42%) and 7 (58%) patients, respectively. After the tonsillectomy, both hematuria score (median 4.25 versus 2.5) and time-averaged UPCR (median 0.63 versus 0.28 g/g) decreased. Five patients achieved hematuria remission and nine patients achieved proteinuria remission and only one patient showed a recurrent urine abnormality. The eGFR slope was changed from mean -11.6 to -0.9 mL/min/1.73m2/year before and after tonsillectomy. Serum IgA after tonsillectomy also changed compared with before (median 394 versus 296 mg/dL).

Conclusion

Adult IgAVN patients who underwent tonsillectomy had relatively favorable clinical courses with improved urinary findings and eGFR slopes. The prospective controlled trial is needed to confirm the efficacy of tonsillectomy in IgAVN.