Tonsillectomy reduces recurrence of IgA nephropathy in mesangial hypercellularity
type categorized by the Oxford classification
#MMPMID26415960
Hirano K
; Amano H
; Kawamura T
; Watanabe K
; Koike K
; Shimizu A
; Endo S
; Tsuboi N
; Okonogi H
; Miyazaki Y
; Ikeda M
; Hanaoka K
; Ogura M
; Komatsumoto S
; Yokoo T
Clin Exp Nephrol
2016[Jun]; 20
(3
): 425-32
PMID26415960
show ga
BACKGROUND: In patients with IgA nephropathy (IgAN), recurrence after steroid
pulse therapy is associated with reduced renal survival. However, the predictors
of recurrence have not yet been clarified. METHODS: All patients who received
6-month steroid pulse therapy from 2004 to 2010 in our four affiliated hospitals
and achieved a reduction of proteinuria to <0.4 g/day 1 year after treatment were
retrospectively evaluated. The primary outcome was proteinuria ?1.0 g/day during
follow-up or additional antiproteinuric therapy. Two histological classifications
were evaluated, the Oxford Classification with a split system and Japanese
histological grades (HGs) with a lumped system. RESULTS: During a median
follow-up of 3.4 years, 27 (26.7 %) of the 101 patients showed recurrence.
Multivariate analysis showed that HG was the only significant predictor of
recurrence, with HG 2+3+4 vs HG 1 having a hazard ratio of 7.38 (95 % confidence
interval 1.52-133). Furthermore, in patients with mesangial hypercellularity
according to the Oxford Classification, cumulative rate of recurrence-free
survival was greater in patients with steroid therapy plus tonsillectomy compared
with those who received steroid therapy alone (Log-rank test, P = 0.022).
However, this association was not observed in patients without mesangial
hypercellularity. CONCLUSIONS: HG is a novel predictor of recurrence after
steroid pulse therapy in patients with IgAN. Moreover, the combination of steroid
pulse therapy plus tonsillectomy may indicate a lower risk of recurrence in
patients with mesangial hypercellularity, as defined by the Oxford
Classification.
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