Tonsillectomy combined with steroid pulse therapy induces clinical remission of IgA nephropathy.

Tonsillectomy combined with steroid pulse therapy has been a popular approach to treating IgA nephropathy (IgAN) in Japan for several years. However, little is understood about how such combined therapy affects the clinical course of IgAN. We therefore compared the effects of the combined therapy with those of steroid pulsing alone in a controlled study of patients with IgAN. The achievement ratio of clinical remission (CR), defined as the disappearance of urinary protein (UP) and occult blood (UOB), were compared between tonsillectomy combined with steroid pulse therapy (n=35) and steroid pulse monotherapy (n=20). The CR rate was higher in the group given combined therapy than that given monotherapy at the final observation 54.0±21.2 months after the initial treatment (54.3 vs. 25.0%, p=0.033). The Cox regression model showed that the combined therapy caused UP to disappear 6-fold more effectively than monotherapy. These findings suggest that tonsillectomy combined with steroid pulse therapy induces CR in patients with IgAN. Meanwhile, the indications for this therapy and verification of its positive longterm prognosis require urgent validation.