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著者: Tetsuya Kawamura, Mitsuhiro Yoshimura, Yoichi Miyazaki, Hidekazu Okamoto, Kenjiro Kimura, Keita Hirano, Masato Matsushima, Yasunori Utsunomiya, Makoto Ogura, Takashi Yokoo, Hideo Okonogi, Takeo Ishii, Akihiko Hamaguchi, Hiroyuki Ueda, Akira Furusu, Satoshi Horikoshi, Yusuke Suzuki, Takanori Shibata, Takashi Yasuda, Sayuri Shirai, Toshiyuki Imasawa, Koichi Kanozawa, Akira Wada, Izumi Yamaji, Naoto Miura, Hirokazu Imai, Kenji Kasai, Jun Soma, Shouichi Fujimoto, Seiichi Matsuo, Yasuhiko Tomino, Special IgA Nephropathy Study Group
雑誌名: Nephrol Dial Transplant. 2014 Aug;29(8):1546-53. doi: 10.1093/ndt/gfu020. Epub 2014 Mar 3.
Abstract/Text
BACKGROUND: The study aim was, for the first time, to conduct a multicenter randomized controlled trial to evaluate the effect of tonsillectomy in patients with IgA nephropathy (IgAN).
METHODS: Patients with biopsy-proven IgAN, proteinuria and low serum creatinine were randomly allocated to receive tonsillectomy combined with steroid pulses (Group A; n = 33) or steroid pulses alone (Group B; n = 39). The primary end points were urinary protein excretion and the disappearance of proteinuria and/or hematuria.
RESULTS: During 12 months from baseline, the percentage decrease in urinary protein excretion was significantly larger in Group A than that in Group B (P < 0.05). However, the frequency of the disappearance of proteinuria, hematuria, or both (clinical remission) at 12 months was not statistically different between the groups. Logistic regression analyses revealed the assigned treatment was a significant, independent factor contributing to the disappearance of proteinuria (odds ratio 2.98, 95% CI 1.01-8.83, P = 0.049), but did not identify an independent factor in achieving the disappearance of hematuria or clinical remission.
CONCLUSIONS: The results indicate tonsillectomy combined with steroid pulse therapy has no beneficial effect over steroid pulses alone to attenuate hematuria and to increase the incidence of clinical remission. Although the antiproteinuric effect was significantly greater in combined therapy, the difference was marginal, and its impact on the renal functional outcome remains to be clarified.
© The Author 2014. Published by Oxford University Press on behalf of ERA-EDTA.
PMID 24596084 Nephrol Dial Transplant. 2014 Aug;29(8):1546-53. doi: 10.1093/ndt/gfu020. Epub 2014 Mar 3.
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