Renal outcome after tonsillectomy plus corticosteroid pulse therapy in patients with immunoglobulin A nephropathy: results of a multicenter cohort study

Background

In addition to renin–angiotensin system inhibition (RAS), corticosteroids are recommended for patients who have immunoglobulin A nephropathy (IgAN) with ≧1 g/day proteinuria. Tonsillectomy plus corticosteroid pulse therapy (TSP) had been reported as more effective in producing clinical remission of IgAN than just oral-corticosteroid (OS) or steroid-pulse (SP) therapy—but that remained unconfirmed. Accordingly, this study compared the effects of TSP, corticosteroid therapies, and RAS on a multicenter, large-scale, long-term cohort.

Methods

1127 biopsy-proven IgAN patients with chronic kidney disease (CKD), G1-3, treated in our hospitals March 1981–December 2013 with TSP (n = 209), SP (n = 103), OS (n = 300), or RAS, alone (n = 515), were followed until end-stage renal disease (ESRD) or death, renal survival compared by treatment and proteinuria level. Hazard ratios (HRs) of ESRD were analyzed after adjusting for sex, age, BMI, eGFR, albumin, proteinuria, hematuria, blood pressure, medications, and renal-biopsy year, with propensity-score-matched analyses performed.

Results

With TSP as referent, the overall HRs of SP, OS, and RAS were, respectively, 1.33 (0.44–4.04), 3.56 (1.45–8.71), and 3.64 (1.48–8.96); with proteinuria ≧1.0 g/gCre, respective HRs were 2.99 (0.71–12.54), 5.04 (1.44–17.67), and 7.23 (1.98–26.40); with proteinuria <1.0 g/gCre, 0.42 (0.04–4.89), 3.24 (0.79–13.30), and 2.05 (0.52–8.05); and for patients with CKD G3, 0.37 (0.10–1.41), 2.14 (0.77–5.94), and 2.03 (0.72–5.72). Similar results were observed in models including pathological grading and/or propensity-score matching.

Conclusion

TSP may decrease the risk of ESRD in IgAN patients better than other therapies in CKD G1-2, with proteinuria ≧1.0 g/gCre, while outcome was similar to SP in CKD G3, or with proteinuria <1.0 g/gCre.