Impact of the number of steroid pulses in tonsillectomy combined with steroid pulse therapy: a nationwide retrospective study in Japan

• DOI: 10.1007/s10157-020-01960-2
• Publication Date: 2020-09-03T11:03:36Z
• Authors: Takahito Moriyama; Hiroshi Kataoka; Kosaku Nitta; Keita Hirano; Keiichi Matsuzaki; Takashi Yasuda; Yoshinari Yasuda; Kentaro Koike; Shoichi Maruyama; Takashi Yokoo; Seiichi Matsuo; Tetsuya Kawamura; Yusuke Suzuki
• Keywords: Adult; Male; Prednisolone; Glomerulonephritis, IGA; Middle Aged; Creatine; Prognosis; Combined Modality Therapy; 3. Good health; Proteinuria; Young Adult; 03 medical and health sciences; 0302 clinical medicine; Japan; Adrenal Cortex Hormones; Risk Factors; Disease Progression; Humans; Female; Glomerular Filtration Rate; Hematuria; Retrospective Studies; Tonsillectomy

Steroid pulse therapy with tonsillectomy is known as a major treatment for IgA nephropathy (IgAN). However, its protocol was different among institutions and the effects of varying the number of steroid pulses remain unclear.From a total of 1,174 IgAN patients in a multicenter retrospective cohort analysis in Japan, 195 patients were treated by tonsillectomy combined with corticosteroid. They were divided into four groups based on the number of administered steroid pulses from 0 to three (TSP0-3), and remission of urinary abnormalities and renal survival until 1.5-fold increase in serum creatinine level from baseline were analyzed among the four groups and between TSP1 and TSP3.Among the four groups, renal function was relatively good when the estimated glomerular filtration rate was approximately 80-90 mL/min/1.73m2 and proteinuria was relatively mild (< 1.0 g/gCre). The ratio of patients who developed renal dysfunction was < 5% in all groups, and the cumulative renal survival rate by Kaplan-Meier analysis was similar among groups (log-rank test, p = 0.37), despite varying clinical backgrounds and treatments. After adjustment of the background variables between TSP1 and TSP3, the remission rates of urinary abnormalities were similar and the renal survival rate also remained similar (66.8 vs. 85.4%, p = 0.45).In patients with mild proteinuria and good renal function, the number of steroid pulses did not affect the renal outcome in steroid pulse therapy with tonsillectomy. The adaptation and protocols, such as the number of steroid pulses, should be determined for each IgAN patient's background.