The efficacy of tonsillectomy on clinical remission and relapse in patients with IgA nephropathy: a randomized controlled trial

Abstract

Background The efficacy of tonsillectomy in immunoglobulin A nephropathy (IgAN) remains controversial. The aim of the study was to conduct a randomized controlled trial to evaluate the effect of tonsillectomy in patients with IgAN. Methods We randomly selected 98 patients with biopsy-proven IgA nephropathy and randomly allocated to receive tonsillectomy combined with drug therapy (Group A) or drug therapy alone (Group B). The participating patients were entered into a 4-year single-center study. Remission and relapse rate were calculated for hematuria and proteinuria using the Kaplan-Meier method. Results No differences were found between the two groups in their baseline clinical and histological characteristics. Patients with tonsillectomy exhibited considerable improvement in the following aspects compared to those patients who did not undergo tonsillectomy: time to reach first remission (3.1 vs. 24.9 months, p50.001) for hematuria and (2.5 vs. 26.1 months, p50.001) for proteinuria, cumulative remission rate (91.8% vs. 46.9%, p50.001 by log-rank test) for hematuria and (95.9% vs. 51.0%, p50.001) for proteinuria, the duration of first remission (26.5 vs. 11.8 months, p ¼ 0.0047) for hematuria and (23.5 vs. 10.5 months, p ¼ 0.0012) for proteinuria, as well as lower relapse rate for hematuria and proteinuria in Group A. Conclusion Our clinical data demonstrated that tonsillectomy could be beneficial for IgAN patients, particularly by contributing to faster and longer remission, as well as reducing the frequency of possible future relapses.

Recent advances in the immunological understanding of association between tonsil and immunoglobulin A nephropathy as a tonsil‐induced autoimmune/inflammatory syndrome

“…The efficacy of tonsillectomy for IgAN has been clinically shown by a recent randomized controlled trials, 52 and it has also been published as a recommended treatment in IgAN clinical practice guidelines. 4 Recently, scientific evidence supporting the use of tonsillectomy has gradually accumulated, and this treatment is being developed not only in Asia 53,54 but also in Europe and the United States.…”

Preventive Effect of Tonsillectomy on Recurrence of Henoch-Schönlein Purpura Nephritis after Intravenous Methylprednisolone Pulse Therapy

“…reduce the incidence of recurrence after CR in adult patients with IgAN (Ohya et al 2013;Hirano et al 2016;Yang et al 2016), whereas this was not supported by the data collected from a European (VALIGA) cohort; Feehally et al 2016reported that IgA nephropathy developed later in 44 Caucasian patients who had undergone tonsillectomy during childhood because of recurrent episodes of tonsillitis and obstructive sleep apnea. Ohya et al (2013) retrospec- Table 3.…”

“…Furthermore, they found that recurrence occurred with almost the same timing in patients with IVMP monotherapy (between 10 and 20 months), which was also similar to the results of the IVMP group in our study (median 13.3 months,. In a recent RCT of Chinese adult patients with IgAN, Yang et al (2016) reported that tonsillectomy combined with drug therapy was more effective than drug therapy alone in both achieving remission and preventing recurrence. They concluded that tonsillectomy can contribute to the preservation of kidney function in IgAN patients.…”

“…Several recent retrospective studies in Asian countries have shown that tonsillectomy is associated with reduction of not only urinary protein excretion but also the future recurrence of IgAN (Ohya et al 2013;Hirano et al 2016;Yang et al 2016). As IgAN and HSPN are considered to share common pathological mechanisms (Rai et al 1999), it may be reasonable to employ similar therapeutic approaches for both clinical entities.…”

Association Between Tonsillectomy and Outcomes in Patients With Immunoglobulin A Nephropathy

“…Two randomized clinical studies on Asian patients (from Japan in 2014 18 and China in 2016 19 ) independently demonstrated that tonsillectomy with corticosteroid treatment improves proteinuria. However, the association between tonsillectomy and long-term renal prognosis remains controversial.…”