Tonsillectomy and steroid pulse (TSP) therapy for patients with IgA nephropathy: a nationwide survey of TSP therapy in Japan and an analysis of the predictive factors for resistance to TSP therapy

Miura, Naoto; Imai, Hirokazu; Kikuchi, Shogo; Hayashi, Shogo; Endoh, Masayuki; Kawamura, Tetsuya; Tomino, Yasuhiko; Moriwaki, Kumiko; Kiyomoto, Hideyasu; Kohagura, Kentaro; Nakazawa, Eiko; Kusano, Eiji; Mochizuki, Toshio; Nomura, Shinsuke; Sasaki, Tatsuya; Kashihara, Naoki; Soma, Jun; Tomo, Tadashi; Nakabayashi, Iwao; Yoshida, Masaharu; Watanabe, Tsuyoshi

doi:10.1007/s10157-009-0179-1

Cited by 65 publications

(34 citation statements)

References 7 publications

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“…In this decade, steroid pulse therapy with [9,10] or without tonsillectomy [11] against nonadvanced IgA nephropathy has been reported, and these therapies have been widely recommended in Japan [12]. However, it is still a therapeutic challenge to treat advanced IgA nephropathy with impaired renal function.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Steroids and Angiotensin Receptor Blockers for Patients with Advanced IgA Nephropathy and Impaired Renal Function

Moriyama

Amemiya²,

Ochi³

et al. 2011

Am J Nephrol

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Background/Aims: The therapeutic strategy for advanced IgA nephropathy patients with impaired renal function is still controversial. Patients and Methods: We divided 44 IgA nephropathy patients with an estimated glomerular filtration rate (eGFR) of less than 60 ml/min/1.76 m² and proteinuria greater than 0.5 g/g · creatinine into two groups: the angiotensin receptor blocker (ARB) group (n = 22), treated with ARBs, and the steroid group (n = 22), treated with corticosteroid. We analyzed the clinical and histological background, renal survival rate until progression to end-stage renal disease (ESRD), and the risk factors for progression. Results: The clinical and histological backgrounds were not significantly different between the groups. At 1 and 2 years after treatment, proteinuria tended to be decreased from baseline in both groups, but not significantly, and urinary red blood cells were significantly decreased in the steroid groups (p < 0.001), but not in the ARB group. The eGFR tended to be increased in the steroid group and decreased in the ARB group. However, the renal survival rate until ESRD was not significantly different between the groups. There were no significant independent risk factors for progression. Conclusion: The beneficial effect of ARBs on renal survival of advanced IgA nephropathy with impaired renal function is equal to that with steroids.

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Section: Discussionmentioning

confidence: 99%

Comparison of Steroids and Angiotensin Receptor Blockers for Patients with Advanced IgA Nephropathy and Impaired Renal Function

Moriyama

Amemiya²,

Ochi³

et al. 2011

Am J Nephrol

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“…Negative prognostic factors for IgAN after tonsillectomy have been reported, and these include an elevated serum total protein level, a higher degree of tonsillar hypertrophy, advanced age, an elevated serum creatinine level, an elevated urinary protein level, an increased serum IgA level, an increased hematuria grade, and a higher pathological grade [15,16]. …”

Section: Introductionmentioning

confidence: 99%

Absence of Mesangial C1q Deposition Is Associated with Resolution of Proteinuria and Hematuria after Tonsillectomy Plus Steroid Pulse Therapy for Immunoglobulin A Nephropathy

Nishiwaki¹,

Hasegawa

Nagayama

et al. 2015

Nephron

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Introduction and Aims: Deposition of C1q occurs in 0 to 45% of patients with IgAN. In order to identify whether mesangial C1q deposition in IgAN is a novel marker for the response to tonsillectomy plus steroid pulse therapy (TSP), we studied the association between mesangial C1q deposition in IgAN and the remission rate after TSP therapy for IgAN. Methods: We conducted a retrospective cohort study at a single Japanese center. We analyzed data on 110 patients diagnosed with IgA nephropathy who received TSP between January 2003 and December 2012. Positive C1q findings were defined as diffuse mesangial C1q deposition. The study outcome was the resolution of abnormal urinary findings and was defined as negative proteinuria and negative occult blood 1 year after steroid pulse therapy. Results: In all enrolled cases, 69 patients (62.7%) went into remission. Ten out of 24 (41.7%) C1q-positive patients experienced remission, and 59 out of 86 (68.6%) C1q-negative patients experienced remission. Multiple logistic regression model analysis showed that the absence of C1q deposition increased the odds ratio for remission (odds ratio 4.41; 95% confidence interval 1.33-15.75, p = 0.017). Conclusions: These results suggest that the absence of diffuse C1q deposition in the mesangial area of the glomerulus in patients with IgA nephropathy is a positive predictive sign for a response to TSP and is associated with the resolution of urinary abnormalities 1 year after TSP.

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“…The Cox regression model analysis showed that the combination therapy was approximately six fold more effective than steroid pulse monotherapy in causing resolution of UP. Their findings were confirmed by Miura et al (2009) in a nationwide survey of IgAN patients who had been treated by tonsillectomy plus steroid pulse therapy in Japan. However, the clinical remission rate of urinary abnormalities varied from less than 10% to more than 90% among the institutions according to differences in the clinical and histological background of the patient populations.…”

Section: ) Steroid Pulse Therapymentioning

confidence: 67%

Tonsillectomy and Steroid Pulse Therapy for IgA Nephropathy

Moriyama

Nitta

2011

Tohoku J. Exp. Med.

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IgA nephropathy (IgAN) is the common cause of primary glomerulonephritis worldwide. The clinical course of IgAN is extremely variable and ranges from asymptomatic microscopic hematuria to rapidly progressive renal failure. The pathogenetic mechanisms of IgAN are still unclear, but a hypothesis consisting of two pathways has been proposed. The first pathway is continuous antigenic stimulation of the innate immune system by the tonsillar mucosa via the mucosa-bone marrow axis. In the second pathway, the anomalous stimulated immune response in the bone marrow results in the production of aberrantly glycosylated IgA1 and its subsequent deposition within the mesangial area. Based on the hypothesis, tonsillectomy plus steroid pulse therapy were introduced. A recent meta-analysis showed that tonsillectomy with or without steroid pulse therapy resulted in clinical remission with favorable long-term efficacy in IgAN patients. Tonsillectomy plus steroid pulse therapy now seems to be an effective treatment for IgAN patients with hematuria and minimal proteinuria, and it is more effective in patients with less severe histological findings. The efficacy of the combination therapy depends on the duration of the IgAN. Randomized, controlled trials are needed to examine the efficacy of tonsillectomy plus steroid pulse therapy in different clinical stages of IgAN.

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Tonsillectomy and steroid pulse (TSP) therapy for patients with IgA nephropathy: a nationwide survey of TSP therapy in Japan and an analysis of the predictive factors for resistance to TSP therapy

Cited by 65 publications

References 7 publications

Comparison of Steroids and Angiotensin Receptor Blockers for Patients with Advanced IgA Nephropathy and Impaired Renal Function

Comparison of Steroids and Angiotensin Receptor Blockers for Patients with Advanced IgA Nephropathy and Impaired Renal Function

Absence of Mesangial C1q Deposition Is Associated with Resolution of Proteinuria and Hematuria after Tonsillectomy Plus Steroid Pulse Therapy for Immunoglobulin A Nephropathy

Tonsillectomy and Steroid Pulse Therapy for IgA Nephropathy

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