Tonsillectomy combined with steroid pulse therapy: a curative therapy for IgA nephropathy.

As IgA nephropathy (IgAN) was originally regarded as a benign condition, the indication of corticosteroids has been highly restricted because of their side effects, and has been used for a specific subgroup of IgAN patients with consideration of the risk/benefit ratio. During the last decade, however, with the recognition that the overall long-term prognosis of IgAN is a non-benign condition, more aggressive treatments, including high dose corticosteroids and tonsillectomy, have been used for a wider subgroup of patients with IgAN. Since 1988, we have treated IgAN patients with steroid semi-pulse therapy combined with tonsillectomy. Over 500 patients with IgAN have been treated with this treatment protocol, and a high percentage of patients enter clinical remission, i.e. free from urinary abnormalities if the combination therapy was initiated in its early stage. Through these experiences we think the goal of treatment of IgAN patients should be changed from "slowing the progression of nephropathy" to "clinical remission".