Tonsillectomy in a European Cohort of 1,147 Patients with IgA Nephropathy.

Abstract

BACKGROUND Tonsillectomy has been considered a treatment for IgA nephropathy (IgAN). It is aimed at removing a source of pathogens, reducing mucosa-associated lymphoid tissue and decreasing polymeric IgA synthesis. However, its beneficial effect is still controversial. In Asia, favorable outcomes have been claimed mostly in association with corticosteroids. In Europe, small, single-center uncontrolled studies have failed to show benefits. METHODS The European validation study of the Oxford classification of IgAN (VALIGA) collected data from 1,147 patients with IgAN over a follow-up of 4.7 years. We investigated the outcome of progression to end-stage renal disease (ESRD) and/or 50% loss of estimated glomerular filtration rate (eGFR) and the annual loss of eGFR in 61 patients who had had tonsillectomy. RESULTS Using the propensity score, which is a logistic regression model, we paired 41 patients with tonsillectomy and 41 without tonsillectomy with similar risk of progression (gender, age, race, mean blood pressure, proteinuria, eGFR at renal biopsy, previous treatments and Oxford MEST scores). No significant difference was found in the outcome. Moreover, we performed an additional propensity score pairing 17 patients who underwent tonsillectomy after the diagnosis of IgAN and 51 without tonsillectomy with similar risk of progression at renal biopsy and subsequent treatments. No significant difference was found in changes in proteinuria, or in the renal end point of 50% reduction in GFR and/or ESRD, or in the annual loss of eGFR. CONCLUSION In the large VALIGA cohort of European subjects with IgAN, no significant correlation was found between tonsillectomy and renal function decline.

DOI: 10.1159/000441852
050010002014201520162017
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@article{Feehally2016TonsillectomyIA, title={Tonsillectomy in a European Cohort of 1,147 Patients with IgA Nephropathy.}, author={John Feehally and Rosanna Coppo and St{\'e}phan Troyanov and Shubha S Bellur and Daniel C. Cattran and Terence H Cook and Ian S. D. Roberts and Jacobien C Verhave and Roberta R. Camilla and Luca Vergano and Jes{\'u}s Egido and Andrzej Wiȩcek and Henryk Karkoszka and Vladim{\'i}r Tesař and Dita Maixnerova and Mai Ots-Rosenberg and Marco Quaglia and Cristiana Rollino and Riccardo Magistroni and Stefano Cusinato and Raffaella Cravero and Licia Peruzzi and Sigrid Lundberg and Loreto Gesualdo and Giovanni C Cancarini and S Feriozzi and Franco Ferrario}, journal={Nephron}, year={2016}, volume={132 1}, pages={15-24} }