Abstract
Background
Because of the well-established annual urinalysis screening system in Japan, the duration of nephropathy (DN) can be estimated in more than half of all patients with IgA nephropathy (IgAN). Treatment using a combination of tonsillectomy and steroid pulse (TSP) therapy has been reported as an effective method for obtaining clinical remission (CR), defined as negative hematuria and proteinuria, in IgAN patients. The present study aims to identify the correlation between DN and CR rate in IgAN patients treated by TSP therapy.
Methods
We retrospectively investigated 830 IgAN patients who were followed up for 81.6 months after TSP therapy. DN could be estimated in 495 of the 830 patients.
Results
The CR rate among patients with DN ≤36 months was 87.3% (295/338 patients). The CR rate among patients with DN of 37–84 months was 73.3% (63/86 patients), while that among patients with DN ≥85 months was 42.3% (30/71 patients). The CR rate among the remaining 335 patients in whom DN could not be estimated because of missing annual urinalysis results was 43.6% (146/335 patients). A multivariate Cox regression model using data from the former group of 495 patients showed that DN ≤36 months was a significant predictor of CR (hazard ratio 1.839; 95% confidence interval 1.410–2.398; P < 0.001).
Conclusion
Shorter DN is associated with higher likelihood of clinical remission in IgAN patients treated by TSP therapy.
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References
D’Amico G, Imbasciati E, Barbiano Di Belgioioso G, Bertoli S, Fogazzi G, Ferrario F, et al. Idiopathic IgA mesangial nephropathy. Clinical and histological study of 374 patients. Medicine. 1985;64:49–60.
Levy M, Berger J. Worldwide perspective of IgA nephropathy. Am J Kidney Dis. 1988;12:340–7.
Donadio JV, Grande JP. IgA nephropathy. N Engl J Med. 2002;347:738–48.
D’Amico G. Natural history of idiopathic IgA nephropathy: role of clinical and histological prognostic factors. Am J Kidney Dis. 2000;36:227–37.
Geddes CC, Rauta V, Gronhagen-Riska C, Bartosik LP, Jardine AG, Ibels LS, et al. A tricontinental view of IgA nephropathy. Nephrol Dial Transplant. 2003;18:1541–8.
Barratt J, Feehally J. Treatment of IgA nephropathy. Kidney Int. 2006;69:1934–8.
Barratt J, Feehally J. IgA nephropathy. J Am Soc Nephrol. 2005;16:2088–97.
Shu KH, Ho WL, Lu YS, Cheng CH, Wu MJ, Lian JD. Long-term outcome of adult patients with minimal urinary abnormalities and normal renal function. Clin Nephrol. 1999;52:5–9.
Sezto CC, Lai FM, To KF, Wong TY, Chow KM, Choi PC, et al. The natural history of immunoglobulin A nephropathy among patients with hematuria and minimal proteinuria. Am J Med. 2001;110:434–7.
Shen P, He L, Li Y, Wang Y, Chan M. Natural history and prognostic factors of IgA nephropathy presented with isolated microscopic hematuria in Chinese patients. Nephron Clin Pract. 2007;106:c157–61.
Koyama A, Igarashi M, Kobayashi M. Members and Coworkers of the Research Group on progressive renal diseases. Natural history and risk factors for immunoglobulin A nephropathy in Japan. Am J Kidney Dis. 1997;29:526–32.
Health and welfare statistics association. 2004 statistical abstracts on health and welfare in Japan. In: Statistical abstracts on health and welfare in Japan 2006. Health and welfare statistics association; 2006.
Hotta O, Miyazaki M, Furuta T, Tomioka S, Chiba S, Horigome I, et al. Tonsillectomy and steroid pulse therapy significantly impact on clinical remission in patients with IgA nephropathy. Am J Kidney Dis. 2001;38:736–43.
Komatsu H, Fujimoto S, Hara S, Sato Y, Yamada K, Kitamura K. Effect of tonsillectomy plus steroid pulse therapy on clinical remission of IgA nephropathy: a controlled study. Clin J Am Soc Nephrol. 2008;3:1301–7.
Suwa N, Takahashi T. Morphological and morphometrical analysis of circulation in hypertension and ischemic kidney. München-Berlin-Wien: Urban & Schwarzenberg; 1971. p. 108–116.
Ootaka T, Suzuki M, Sudo K, Sato H, Seino J, Saito T, et al. Histological localization of terminal complement complexes in renal diseases: an immunohistochemical study. Am J Clin Pathol. 1989;91:144–51.
Hotta O, Taguma Y, Kurosawa K, Sudo K, Suzuki K, Horigome I. Predictive value of small crescents in IgA nephropathy: analysis of four patients showing a deteriorated renal function during a long follow-up period. Clin Nephrol. 1993;40:125–30.
Sato Y, Hotta O, Taguma Y, Takasaka T, Nose M. IgA nephropathy with poorly development lymphoepithelial symbiosis of the palatine tonsils. Nephron. 1996;74:301–8.
Schena FP. A retrospective analysis of the natural history of primary IgA nephropathy worldwide. Am J Med. 1990;89:209–15.
Hall CL, Bradley R, Kerr A, Attoti R, Peat D. Clinical value of renal biopsy in patients with asymptomatic microscopic hematuria with and without low-grade proteinuria. Clin Nephrol. 2004;62:267–72.
Hotta O. Use of corticosteroids, other immunosuppressive therapies, and tonsillectomy in the treatment of IgA nephropathy. Seminars in Nephrol. 2004;24:244–55.
Droz D, Kramar A, Nawar T, Noël LH. Primary IgA nephropathy: prognostic factors. Contrib Nephrol. 1984;40:202–7.
Nicholls KM, Fairley KF, Downling JP, Kincaid-Smith P. The clinical course of mesangial IgA associated nephropathy in adults. Q J Med. 1984;53:227–50.
Beukhof JR, Kardaun O, Schaafsma W, Poortema K, Donker AJ, Hoedemaeker PJ, et al. Toward individual prognosis of IgA nephropathy. Kidney Int. 1986;29:549–56.
Haas M. Histologic subclassification of IgA nephropathy: a clinicopathologic study of 244 cases. Am J Kidney Dis. 1997;29:829–42.
Frimat L, Briançon S, Hestin D, Aymard B, Renoult E, Cao Huu T, Kessler M. IgA nephropathy: prognostic classification of end-stage renal failure. L’Association des Néphrologues de l’Est. Nephrol Dial Transplant. 1997;12:2569–75.
Kobayashi Y, Kokubo T, Horii A, Hiki Y, Tateno S. Prognostic prediction of long-term clinical courses in individual IgA nephropathy patients. Nephrology. 1997;3:35–40.
Reich HN, Troyanov S, Scholey JW, Cattran DC, Toronto Glomerulonephritis Registry. Remission of proteinuria improved prognosis in IgA nephropathy. J Am Soc Nephrol. 2007;18:3177–83.
Radford MG, Donadio JV, Bergstralh EJ, Grande JP. Predicting renal outcome in IgA nephropathy. J Am Soc Nephrol. 1997;8:199–207.
Donadio JV, Bergstralth EJ, Offord KP, Holley KE, Spencer DC. Clinical and histopathologic associations with impaired renal function in IgA nephropathy. Mayo Nephrology Collaborative Group. Clin Nephrol. 1994;41:65–71.
Bartosik LP, Lajoie G, Sugar L, Cattran DC. Predicting progression in IgA nephropathy. Am J Kidney Dis. 2001;38:728–35.
Feehally J. Predicting prognosis in IgA nephropathy. Am J Kidney Dis. 2001;38:881–3.
Lee HS, Lee MS, Lee SM, Lee SY, Lee ES, Lee EY, et al. Histological grading of IgA nephropathy predicting renal outcome: revisiting H. S. Lee’s glomerular grading system. Nephrol Dial Transplant. 2005;20:342–8.
Feriozzi S, Pierucci A, Roscia E, Cinotti GA, Pecci G. Angiotensin converting enzyme inhibition delays the progression of chronic renal failure in hypertensive patients with immunoglobulin A nephropathy. J Hypertens. 1989;7:S63–4.
Remuzzi A, Perticucci E, Ruggeneti P, Mosconi L, Limonta M, Remuzzi G. Angiotensin converting enzyme inhibition improves glomerular size-selectivity in IgA nephropathy. Kidney Int. 1991;39:1247–73.
Rekola S, Bergstrand A, Butch H. Deterioration rate in hypertensive IgA nephropathy: comparison of a converting enzyme inhibitor and beta-blocking agents. Nephron. 1991;59:57–60.
Maschio G, Cagnoli L, Claroni F, Fusaroli M, Rugiu C, Sanna G, et al. ACE inhibition reduces proteinuria in normotensive patients with IgA nephropathy: a multicentre, randomized, placebo-controlled study. Nephrol Dial Transplant. 1994;9:265–9.
Cattran D, Greenwood BS, Math M, Ritchie MD. Long-term benefits of angiotensin-converting enzyme inhibitor therapy in patients with severe immunoglobulin A nephropathy: a comparison to patients receiving treatment with other antihypertensive agents and to patients receiving no therapy. Am J Kidney Dis. 1994;23:247–54.
Lewis EJ, Hunsicker L, Bain RP, Rhode RP, for the Collaborative Study Group. The effect of angiotensin-converting-enzyme inhibition on diabetic nephropathy. N Engl J Med. 1993;329:1456–62.
The GISEN Group. Randomised placebo-controlled trial of effect of ramipril on declining in glomerular filtration rate and risk of terminal renal failure in proteinuric, non-diabetic nephropathy. Lancet. 1997;349:1857–63.
Appel GB, Waldman M. The IgA nephropathy treatment dilemma. Kidney Int. 2006;69:1939–44.
Rauta V, Finne P, Fagerudd J, Rosenlöf K, Törnroth T, Grönhagen-Riska C. Factors associated with progression of IgA nephropathy are related to renal function—a model for estimating risk of progression in mild disease. Clin Nephrol. 2002;58:85–94.
Hotta O, Furuta T, Chiba S, Tomioka S, Taguma Y. Regression of IgA nephropathy: a repeat biopsy study. Am J Kidney Dis. 2002;39:493–502.
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Ieiri, N., Hotta, O., Sato, T. et al. Significance of the duration of nephropathy for achieving clinical remission in patients with IgA nephropathy treated by tonsillectomy and steroid pulse therapy. Clin Exp Nephrol 16, 122–129 (2012). https://doi.org/10.1007/s10157-011-0530-1
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DOI: https://doi.org/10.1007/s10157-011-0530-1