Efficacy of tonsillectomy pulse therapy versus multiple-drug therapy for IgA nephropathy

Abstract

We evaluated the efficacy of tonsillectomy plus pulse prednisolone, warfarin, and dipyridamole including methylprednisolone pulse (tonsillectomy plus pulse therapy), versus prednisolone, warfarin, and dipyridamole including mizoribine (PWDM) for the treatment diffuse IgA nephropathy (IgAN) in children. The patients were randomly assigned to be treated by tonsillectomy plus pulse therapy for 2 years (Group A, n=16) or PWDM for 2 years (Group B, n=16). The clinical features and pathological findings in both groups were analyzed prospectively. The mean urinary protein excretion after 6 months of treatment in both groups had decreased significantly compared with pre-therapy. The activity index (AI) in both groups was lower at the time of the second biopsy than at the time of the first biopsy. The chronicity index (CI) in Groups A and B did not differ between the first and second biopsy. At the latest follow-up examination none (0%) of the patients in either group had renal insufficiency. None of the patients in Group A, but six patients in Group B experienced an acute exacerbation of IgAN as a result of tonsillitis (P<0.05). In conclusion, although there was no untreated control group in this study, the results suggested that tonsillectomy plus pulse therapy is as effective as PWDM in ameliorating proteinuria and histological severity in IgAN patients and in preventing acute exacerbation of IgAN by tonsillitis.

Tonsillectomy with Methylprednisolone Pulse Therapy as Rescue Treatment for Steroid-Resistant IgA Nephropathy in Children

“…Masuda et al (1988) observed improvement on urinalysis in all of seven Japanese children with IgAN who underwent tonsillectomy. In addition, we previously reported that that tonsillectomy pulse therapy is as effective as PWD with mizoribine in ameliorating proteinuria and histological severity as an initial treatment in IgAN patients and in preventing acute exacerbation of IgAN by tonsillitis, although no untreated control group has included in that study (Kawasaki et al 2006). However, no reports on the efficacy of tonsillectomy pulse therapy as rescue treatment for steroid-resistant IgAN in childhood have been available.…”

“…A retrospective analysis showed that approximately 60% of their patients who underwent tonsillectomy pulse therapy achieved remission of urinary abnormalities (Hotta et al 2001). We also reported that tonsillectomy pulse therapy was effective as an initial treatment for IgAN in pediatric patients (Kawasaki et al 2006). However, there have been no reports on the efficacy of tonsillectomy pulse therapy as rescue treatment for steroid-resistant IgAN in childhood.…”

“…On the other hand, there have been some reports on the efficacy of tonsillectomy for IgAN in adults and children (Lozano et al 1985;Hotta et al 2001;Kawasaki et al 2006;Komatsu et al 2008). Hotta et al (2001) initially described tonsillectomy with methylprednisolone (MP) pulse therapy (tonsillectomy pulse therapy), which then became a popular approach to treating IgAN for several years in Japan.…”

Successful therapy with tonsillectomy plus pulse therapy for the relapse of pediatric IgA nephropathy treated with multi-drugs combination therapy

“…In addition, based on a mata -analysis, Liu et al reported that tonsillectomy may induce clinical remission and reduce the rate of progression to end -stage renal disease in patients with IgAN 17,18) . We also reported that TMP as an initial therapy for pediatric IgAN was effective in a short -term follow -up study 15) . Our case presented herein further suggest that TMP was effective as a rescue therapy for recurrent severe IgAN after multi -drug combination therapy.…”

Efficacy of Tonsillectomy Plus Methylprednisolone Pulse Therapy for a Child with Henoch-Schoenlein Purpura Nephritis

“…Hotta et al reported that tonsillectomy plus methylprednisolone pulse therapy led to clinical remission in adult patients with IgAN (Hotta et al 2001). In addition, we reported that tonsillectomy pulse therapy was effective for severe IgAN in childhood (Kawasaki et al 2006). Wyatt and Hogg (2001), on the other hand, claimed that tonsillectomy cannot be recommended for IgAN by evidence-based criteria.…”