Department of Medical and Surgical Sciences, Nephrology Clinic, University of Padova, Padova, Italy.
Nephrol Dial Transplant. 2010 Aug;25(8):2583-9. doi: 10.1093/ndt/gfq107. Epub 2010 Mar 2.
Little information is available about the efficacy of tonsillectomy on long-term renal survival of patients with primary IgA nephropathy (IgAN).
In this retrospective cohort study, we considered 61 patients with IgAN who had tonsillectomy (n = 15) or not (n = 46) and compared them with 121 control patients with mesangioproliferative glomerulonephritis (MesGN) free of IgA deposits, who had tonsillectomy (n = 49) or not (n = 72). We evaluated the progression from a normal function [estimated glomerular filtration rate 60-220 mL/min/1.73 m(2), chronic kidney disease (CKD) stage 1 and 2] to a moderate renal dysfunction in CKD stage 3, which was considered the outcome.
The mean duration of follow-up was 250 months (12-300 months) in the whole group of 182 patients. The survival to progression to stage 3 was 88% after 10 years, 71% after 20 years and 53% after 25 years. It was 72% after 20 years in both groups. Tonsillectomy was not significantly associated with CKD progression. Significant prognostic factors were age (P = 0.01), initial CKD stage (P = 0.03), proteinuria (P = 0.03), persistent proteinuria (P < 0.001) and diastolic blood pressure (P = 0.01). In the multivariate analysis (Cox model), there was no significant effect of tonsillectomy adjusted for the type of glomerulonephritis, initial CKD stage, persistent proteinuria, diastolic blood pressure and age. Only persistent proteinuria adjusted for the other factors was significantly associated with CKD progression (hazard ratio of 6.2, 95% confidence interval 3.1-12.7, P < 0.001).
Tonsillectomy was not associated with a different progression rate of IgAN nor of MesGN after 20 years of follow-up.
关于扁桃体切除术对原发性 IgA 肾病（IgAN）患者长期肾脏生存的疗效，相关信息较少。
在这项回顾性队列研究中，我们纳入了 61 例接受扁桃体切除术（n=15）或未接受扁桃体切除术（n=46）的 IgAN 患者，并与 121 例无 IgA 沉积的系膜增生性肾小球肾炎（MesGN）患者进行比较，这些患者接受了扁桃体切除术（n=49）或未接受扁桃体切除术（n=72）。我们评估了从正常功能（估算肾小球滤过率 60-220mL/min/1.73m2，慢性肾脏病[CKD]1 期和 2 期）向 CKD 3 期中度肾功能障碍的进展，这被认为是结局。
在 182 例患者的整个队列中，平均随访时间为 250 个月（12-300 个月）。10 年后，进展至 CKD 3 期的存活率为 88%，20 年后为 71%，25 年后为 53%。20 年后两组的存活率均为 72%。扁桃体切除术与 CKD 进展无显著相关性。显著的预后因素为年龄（P=0.01）、初始 CKD 分期（P=0.03）、蛋白尿（P=0.03）、持续性蛋白尿（P<0.001）和舒张压（P=0.01）。在多变量分析（Cox 模型）中，在校正肾小球肾炎类型、初始 CKD 分期、持续性蛋白尿、舒张压和年龄后，扁桃体切除术无显著影响。只有在校正其他因素后的持续性蛋白尿与 CKD 进展显著相关（风险比 6.2，95%置信区间 3.1-12.7，P<0.001）。
在 20 年的随访后，扁桃体切除术与 IgAN 或 MesGN 的进展速度无差异。
