Early tonsillectomy for severe immunoglobulin A nephropathy significantly reduces proteinuria.
Adolescent
Child
Child, Preschool
Combined Modality Therapy
Creatinine
/ blood
Female
Glomerulonephritis, IGA
/ drug therapy
Glucocorticoids
/ therapeutic use
Hematuria
/ diagnosis
Humans
Kidney
/ pathology
Male
Methylprednisolone
/ therapeutic use
Prognosis
Proteinuria
/ diagnosis
Pulse Therapy, Drug
/ methods
Time Factors
Tonsillectomy
/ methods
Treatment Outcome
Uric Acid
/ analysis
childhood
long-term prognosis
proteinuria
severe IgA nephropathy
tonsillectomy
Journal
Pediatrics international : official journal of the Japan Pediatric Society
ISSN: 1442-200X
Titre abrégé: Pediatr Int
Pays: Australia
ID NLM: 100886002
Informations de publication
Date de publication:
Sep 2020
Sep 2020
Historique:
received:
30
01
2020
revised:
14
03
2020
accepted:
15
04
2020
pubmed:
22
4
2020
medline:
19
5
2021
entrez:
22
4
2020
Statut:
ppublish
Résumé
Early multiple-drug therapy for severe childhood immunoglobulin A (IgA) nephropathy prevents the progression of nephritis and improves the long-term prognosis. Recent studies have focused on the relationship between the pathophysiology of IgA nephropathy and tonsillar focal infection, and the efficacy of tonsillectomy with methylprednisolone pulse therapy in children has been demonstrated. However, no study has reported on the relationship between the period from diagnosis to tonsillectomy and the long-term prognosis of IgA nephropathy. To clarify the long-term effects of an early tonsillectomy, 40 patients who were diagnosed with severe IgA nephropathy in childhood and underwent a tonsillectomy were divided into two groups based on the period from diagnosis to undergoing tonsillectomy: Group A, less than 3 years; and Group B, more than 3 years. The primary endpoint of this study was the change in the amount of proteinuria. Renal prognosis was evaluated 10 years after the diagnosis. This study enrolled 40 patients diagnosed with severe IgA nephropathy in childhood who underwent tonsillectomy after multiple-drug therapy with/without methylprednisolone pulse therapy at Kindai University Hospital; eight patients were excluded based on the exclusion criteria. Group A consisted of 18 patients and Group B, 14 patients. Proteinuria and hematuria levels were significantly reduced in the early surgery group (P < 0.01). No significant differences were found in serum creatinine, uric acid, and IgA/C3 ratio. High proteinuria levels worsen the renal prognosis in IgA nephropathy. Tonsillectomy in less than 3 years combined with multiple-drug therapy after the initial diagnosis could improve long-term prognosis.
Sections du résumé
BACKGROUND
BACKGROUND
Early multiple-drug therapy for severe childhood immunoglobulin A (IgA) nephropathy prevents the progression of nephritis and improves the long-term prognosis. Recent studies have focused on the relationship between the pathophysiology of IgA nephropathy and tonsillar focal infection, and the efficacy of tonsillectomy with methylprednisolone pulse therapy in children has been demonstrated. However, no study has reported on the relationship between the period from diagnosis to tonsillectomy and the long-term prognosis of IgA nephropathy.
METHODS
METHODS
To clarify the long-term effects of an early tonsillectomy, 40 patients who were diagnosed with severe IgA nephropathy in childhood and underwent a tonsillectomy were divided into two groups based on the period from diagnosis to undergoing tonsillectomy: Group A, less than 3 years; and Group B, more than 3 years. The primary endpoint of this study was the change in the amount of proteinuria. Renal prognosis was evaluated 10 years after the diagnosis.
RESULTS
RESULTS
This study enrolled 40 patients diagnosed with severe IgA nephropathy in childhood who underwent tonsillectomy after multiple-drug therapy with/without methylprednisolone pulse therapy at Kindai University Hospital; eight patients were excluded based on the exclusion criteria. Group A consisted of 18 patients and Group B, 14 patients. Proteinuria and hematuria levels were significantly reduced in the early surgery group (P < 0.01). No significant differences were found in serum creatinine, uric acid, and IgA/C3 ratio.
CONCLUSIONS
CONCLUSIONS
High proteinuria levels worsen the renal prognosis in IgA nephropathy. Tonsillectomy in less than 3 years combined with multiple-drug therapy after the initial diagnosis could improve long-term prognosis.
Substances chimiques
Glucocorticoids
0
Uric Acid
268B43MJ25
Creatinine
AYI8EX34EU
Methylprednisolone
X4W7ZR7023
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1054-1057Informations de copyright
© 2020 Japan Pediatric Society.
Références
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