Association Between Tonsillectomy and Outcomes in Patients With Immunoglobulin A Nephropathy

There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

Key Points

Question

Is there an association between undergoing tonsillectomy within 1 year of the initial diagnosis of IgA nephropathy and the subsequent renal outcome?

Findings

In this cohort study of 1065 Japanese patients with IgA nephropathy diagnosed between 2002 and 2004, the matched patients who underwent tonsillectomy had a lower risk of renal events than those who did not undergo the procedure.

Meaning

Tonsillectomy may improve renal survival rates in patients with IgA nephropathy independent of conventional therapy using renin-angiotensin system inhibitors and corticosteroids.

Abstract

This cohort study investigates the association between tonsillectomy and renal outcomes in patients with IgA nephropathy in Japan.

Abstract

Importance

Immunoglobulin A nephropathy is a major cause of end-stage renal disease worldwide; previous methods of medical management, including use of renin-angiotensin system inhibitors and corticosteroids, remain unproven in clinical trials.

Objective

To investigate the possible association between tonsillectomy and outcomes in patients with IgA nephropathy.

Design, Setting, and Participants

This cohort study included 1065 patients with IgA nephropathy enrolled between 2002 and 2004 and divided into 2 groups, those who underwent tonsillectomy and those who did not. Initial treatments (renin-angiotensin system inhibitors or corticosteroids) within 1 year after renal biopsy were also evaluated. A 1:1 propensity score matching was performed to account for between-group differences and 153 matched pairs were obtained. Follow-up concluded January 31, 2014. Analysis was conducted between September 11, 2017, and July 31, 2018.

Exposure

Tonsillectomy.

Main Outcomes and Measures

The primary outcome was the first occurrence of a 1.5-fold increase in serum creatinine level from baseline or dialysis initiation. Secondary outcomes included additional therapy with renin-angiotensin system inhibitors or corticosteroids initiated 1 year after renal biopsy and adverse events.

Results

In 1065 patients (49.8% women; median [interquartile range] age, 35 [25-52] years), the mean (SD) estimated glomerular filtration rate was 76.6 (28.9) mL/min/1.73 m ² and the median (interquartile range) proteinuria was 0.68 (0.29-1.30) g per day. In all, 252 patients (23.7%) underwent tonsillectomy within 1 year after renal biopsy and 813 patients (76.3%) did not undergo tonsillectomy. The primary outcome was reached by 129 patients (12.1%) during a median (interquartile range) follow-up of 5.8 (1.9-8.5) years. In matching analysis, tonsillectomy was associated with primary outcome reduction (hazard ratio, 0.34; 95% CI, 0.13-0.77; P = .009). In subgroup analyses, benefit associated with tonsillectomy was not modified by baseline characteristic differences. Those undergoing tonsillectomy required fewer additional therapies 1 year following renal biopsy (adjusted hazard ratio, 0.37; 95% CI, 0.20-0.63; P < .001) without increased risks for adverse events, except transient tonsillectomy-related complications.

Conclusions and Relevance

This study found that tonsillectomy was associated with a lower risk of renal outcomes in patients with IgA nephropathy. The potential role of tonsillectomy should be considered for preventing end-stage renal disease in patients with IgA nephropathy.

Related collections

Most cited references 24

Record: found
Abstract: found
Article: not found

Decline in estimated glomerular filtration rate and subsequent risk of end-stage renal disease and mortality.

Josef Coresh, Tanvir Turin, Kunihiro Matsushita … (2014)

The established chronic kidney disease (CKD) progression end point of end-stage renal disease (ESRD) or a doubling of serum creatinine concentration (corresponding to a change in estimated glomerular filtration rate [GFR] of −57% or greater) is a late event. To characterize the association of decline in estimated GFR with subsequent progression to ESRD with implications for using lesser declines in estimated GFR as potential alternative end points for CKD progression. Because most people with CKD die before reaching ESRD, mortality risk also was investigated. Individual meta-analysis of 1.7 million participants with 12,344 ESRD events and 223,944 deaths from 35 cohorts in the CKD Prognosis Consortium with a repeated measure of serum creatinine concentration over 1 to 3 years and outcome data. Transfer of individual participant data or standardized analysis of outputs for random-effects meta-analysis conducted between July 2012 and September 2013, with baseline estimated GFR values collected from 1975 through 2012. End-stage renal disease (initiation of dialysis or transplantation) or all-cause mortality risk related to percentage change in estimated GFR over 2 years, adjusted for potential confounders and first estimated GFR. The adjusted hazard ratios (HRs) of ESRD and mortality were higher with larger estimated GFR decline. Among participants with baseline estimated GFR of less than 60 mL/min/1.73 m2, the adjusted HRs for ESRD were 32.1 (95% CI, 22.3-46.3) for changes of −57% in estimated GFR and 5.4 (95% CI, 4.5-6.4) for changes of −30%. However, changes of −30% or greater (6.9% [95% CI, 6.4%-7.4%] of the entire consortium) were more common than changes of −57% (0.79% [95% CI, 0.52%-1.06%]). This association was strong and consistent across the length of the baseline period (1 to 3 years), baseline estimated GFR, age, diabetes status, or albuminuria. Average adjusted 10-year risk of ESRD (in patients with a baseline estimated GFR of 35 mL/min/1.73 m2) was 99% (95% CI, 95%-100%) for estimated GFR change of −57%, was 83% (95% CI, 71%-93%) for estimated GFR change of −40%, and was 64% (95% CI, 52%-77%) for estimated GFR change of −30% vs 18% (95% CI, 15%-22%) for estimated GFR change of 0%. Corresponding mortality risks were 77% (95% CI, 71%-82%), 60% (95% CI, 56%-63%), and 50% (95% CI, 47%-52%) vs 32% (95% CI, 31%-33%), showing a similar but weaker pattern. Declines in estimated GFR smaller than a doubling of serum creatinine concentration occurred more commonly and were strongly and consistently associated with the risk of ESRD and mortality, supporting consideration of lesser declines in estimated GFR (such as a 30% reduction over 2 years) as an alternative end point for CKD progression.

0 comments Cited 364 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: not found
Article: not found

[Intercapillary deposits of IgA-IgG].

N HINGLAIS-GUILLAUD, J. Berger (1968)

0 comments Cited 89 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: not found

Corticosteroid effectiveness in IgA nephropathy: long-term results of a randomized, controlled trial.

Simeone Andrulli, C Pozzi, G B Fogazzi … (2003)

Proteinuria plays a causal role in the progression of IgA nephropathy (IgAN). A previous controlled trial showed that steroids are effective in reducing proteinuria and preserving renal function in patients with IgAN. The objective of this study was to evaluate the long-term effectiveness of steroids in IgAN, examine the trend of proteinuria during follow-up (starting from the hypothesis that the degree of reduction in proteinuria may influence IgAN outcome), and evaluate how histologic scores can influence steroid response. A secondary analysis of a multicenter, randomized, controlled trial of 86 adult IgAN patients who were receiving supportive therapy or intravenous methylprednisolone plus oral prednisone for 6 mo was conducted. Ten-year renal survival was significantly better in the steroid than in the control group (97% versus 53%; log rank test P = 0.0003). In the 72 patients who did not reach the end point (doubling in baseline serum creatinine), median proteinuria significantly decreased (1.9 g/24 h at baseline, 1.1 g/24 h after 6 mo, and 0.6 g/24 h after a median of 7 yr). In the 14 progressive patients, proteinuria increased from a median of 1.7 g/24 h at baseline to 2.0 g/24 h after 6 mo and 3.3 g/24 h after a median of 5 yr. Steroids were effective in every histologic class. Cox multivariate regression analyses showed that, in addition to steroids, a low baseline histologic score, a reduction in proteinuria after 6 mo, and no increase in proteinuria during follow-up all were independent predictors of a beneficial outcome. Steroids significantly reduce proteinuria and protect against renal function deterioration in IgAN. The histologic picture and proteinuria during early and late follow-up improve the prediction of outcome, but considerable variability remains outside the model.

0 comments Cited 82 times – based on 0 reviews      Review now

Bookmark

All references

Author and article information

Journal

Journal ID (nlm-ta): JAMA Netw Open

Journal ID (iso-abbrev): JAMA Netw Open

Journal ID (pmc): JAMA Netw Open

Title: JAMA Network Open

Publisher: American Medical Association

ISSN (Electronic): 2574-3805

Publication date (Electronic): 31 May 2019

Publication date Collection: May 2019

Publication date PMC-release: 31 May 2019

Volume: 2

Issue: 5

Electronic Location Identifier: e194772

Affiliations

[1 ]Division of Nephrology, Department of Internal Medicine, Ashikaga Red Cross Hospital, Ashikaga, Japan

[2 ]Division of Nephrology and Hypertension, Department of Internal Medicine, Jikei University School of Medicine, Tokyo, Japan

[3 ]Department of Nephrology, Juntendo University Faculty of Medicine, Tokyo, Japan

[4 ]Kyoto University Health Service, Kyoto, Japan

[5 ]Department of Internal Medicine, Kichijoji Asahi Hospital, Kyoto, Japan

[6 ]Clinical Research Support Center, Jikei University School of Medicine, Tokyo, Japan

[7 ]Department of Nephrology, Nagoya University, Nagoya, Japan

Author notes

Article Information

Accepted for Publication: April 9, 2019.

Published: May 31, 2019. doi:10.1001/jamanetworkopen.2019.4772

Corresponding Author: Tetsuya Kawamura, MD, PhD, Division of Kidney and Hypertension, Department of Internal Medicine, Jikei University School of Medicine, 3-25-8 Nishi-Shinbashi, Minato-Ku, Tokyo 105-8461, Japan ( kawatetu@ 123456coral.ocn.ne.jp ).

Author Contributions: Drs Hirano and Kawamura had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Drs Hirano and Matsuzaki contributed equally to this work.

Concept and design: Hirano, Matsuzaki, T. Yasuda, Nishikawa, Y. Yasuda, Maruyama, Matsuo, Kawamura, Suzuki.

Acquisition, analysis, or interpretation of data: Hirano, Matsuzaki, Nishikawa, Y. Yasuda, Koike, Yokoo, Kawamura.

Drafting of the manuscript: Hirano, Matsuzaki, Y. Yasuda, Maruyama, Kawamura, Suzuki.

Critical revision of the manuscript for important intellectual content: Hirano, Matsuzaki, T. Yasuda, Nishikawa, Koike, Yokoo, Matsuo, Kawamura, Suzuki.

Statistical analysis: Hirano, Matsuzaki, Nishikawa, Koike, Yokoo, Kawamura.

Obtained funding: Hirano, Kawamura.

Administrative, technical, or material support: Hirano, Matsuzaki, Y. Yasuda, Suzuki.

Supervision: Hirano, Matsuzaki, Maruyama, Kawamura, Suzuki.

Conflict of Interest Disclosures: Dr Y. Yasuda reported grants from the Ministry of Health, Labour and Welfare of Japan during the conduct of the study; grants and personal fees from Dainippon Sumitomo, Merck Sharp & Dohme, Kirin, Boehringer Ingelheim, Kowa, Sanwakagaku, and Chugai; personal fees from Astellas, Tanabe Mitsubishi, Fujiyakuhin, Takeda, Daiichisankyo, and Mochida; and grants from Nipro and Kureha outside the submitted work. No other disclosures were reported.

Funding/Support: This study was supported in part by a Grant-in-Aid for Progressive Renal Diseases Research, Research on Rare and Intractable Disease, from the Ministry of Health, Labour and Welfare of Japan.

Role of the Funder/Sponsor: The funder had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Additional Contributions: We thank the study participants and the clinicians for their kind cooperation. We also thank Enago for the English language review, for which the company was compensated.

Article

Publisher ID: zoi190201

DOI: 10.1001/jamanetworkopen.2019.4772

PMC ID: 6547111

PubMed ID: 31150076

SO-VID: d7072ee9-9113-4987-86d5-89f407695bc3

License:

This is an open access article distributed under the terms of the CC-BY License.

History

Date received : 12 February 2019

Date: 8 April 2019

Date accepted : 9 April 2019

Comments

Comment on this article

scite_

Cited by 27

See all cited by

Most referenced authors 743

See all reference authors

Association Between Tonsillectomy and Outcomes in Patients With Immunoglobulin A Nephropathy

Read this article at

Key Points

Question

Findings

Meaning

Abstract

Abstract

Importance

Objective

Design, Setting, and Participants

Exposure

Main Outcomes and Measures

Results

Conclusions and Relevance

Related collections

Association of European University Presses (AEUP)

Most cited references 24

Decline in estimated glomerular filtration rate and subsequent risk of end-stage renal disease and mortality.

[Intercapillary deposits of IgA-IgG].

Corticosteroid effectiveness in IgA nephropathy: long-term results of a randomized, controlled trial.

Author and article information

Journal

Affiliations

Author notes

Article

History

Categories

Comments

Comment on this article

Similar content 1,257

Cited by 27

Most referenced authors 743