Tonsillectomy delays progression of advanced IgA nephropathy to end-stage kidney disease

摘要

Aims: Several investigators have described the effect of tonsillectomy on urinary abnormalities and long-term renal survival rates in patients with IgA nephropathy (IgAN), especially during the early stage of the disease. However, whether tonsillectomy affects the rate of IgAN progress, even when the disease is in the advanced stage, remains obscure. Methods: Of 365 patients who were histologically diagnosed with IgAN, 46 eventually reached end-stage kidney disease (ESKD) between 1981 and 2006. The periods from diagnosis to ESKD with renal replacement therapy (RRT) were compared between patients with ESKD who had undergone tonsillectomy (n = 15) as initial therapy for IgAN or not (n = 31). Relationships among risk factors, initial treatment, and rates of progression to ESKD were also examined using multivariate analysis in a retrospective cohort study of the 46 patients. Results: The duration between renal biopsy and initiation of RRT was significantly extended for patients with, than without, tonsillectomy (9.8 ± 6.0 vs. 5.8 ± 4.0 years, p = 0.007; unpaired t-test). The RRT-free survival advantage in patients with tonsillectomy was also evident in KaplanMeier curves (p = 0.007 by log-rank test). Logistic regression analysis showed that a high serum creatinine value at biopsy and severe histological damage were risk factors affecting rapid progression (within 7 years from diagnosis) to ESKD, whereas tonsillectomy apparently delayed disease progression [odds ratio, 0.09; 95% confidence interval (CI), 0.010.75; p = 0.026]. Conclusion: Tonsillectomy might delay the rate of progression even when IgAN is relatively advanced, although this study could not confirm whether it prevents progression to ESKD.