IGA NEPHROPATHY PAPERS TO READ

IGA NEPHROPATHY PAPERS TO READ

I am renewing my effort to share the knowledge of this disease and treatment after more than ten years away from my original web site the IgA Nephropathy Foundation. I hope it helps.

Here’s a collection of medical science papers to read if you or a loved one has IgA Nephropathy. I’ve been engaged in a heated debate with some in the medical community about the effectiveness of tonsillectomy in treating IgA Nephropathy. The simple fact is that IgAN is an auto-immune disease and in particular one kidney membranes are attacked by the components of the immune system that derive from the thymus immune system. The big players in the thymus derived immune system are tonsils. French doctors who first identified IgAN called the disease “the kidney disease of people with frequent sore throats.”

Stopping the onslaught of your immune system on the vital and delicate membranes of your kidneys can be accomplished with potent immune suppressants like steroids or even transplant anti-rejection drugs like mycophenolate mofetil, they are tough drugs to take.  Tonsillectomy simply surgically removes a big part of the immune system that is making the molecules that are damaging the kidney membranes. It worked for me and for thousands of people I shared my experience with when I had a website called the IgA Nephropathy Foundation.

You will see that most of the citations come from PubMed which is a free medical literature library… if you click through to it you can figure out how to do a lot of reading and research …. it’s way easier than what I had to do back in the nineties rummaging through dusty stacks of hard copy medical journals and reports to figure out how to save my own life.

Healthy Reading

Arch Otolaryngol Head Neck Surg. 2009 Jan;135(1):85-7. doi: 10.1001/archoto.2008.509.
The role of tonsillectomy in pediatric IgA nephropathy.
Mariotti AJ, Agrawal R, Hotaling AJ.
Source: Department of Otolaryngology-Head and Neck Surgery, Loyola University Medical Center, Maywood, IL 60153, USA.
Abstract
OBJECTIVES: To review pediatric cases of IgA nephropathy (IgAN) in 6 patients who underwent tonsillectomy and had marked improvement of their renal symptoms and to review the appropriate indications for tonsillectomy for this disease.
DESIGN: Retrospective case series.
SETTING: Academic medical center.
PATIENTS: Six children (age range, 8-15 years) with renal biopsy-proved IgAN who were referred by a pediatric nephrologist for recurrent tonsillitis.
INTERVENTION: Tonsillectomy.
MAIN OUTCOME MEASURES: Resolution of clinical features of IgAN, including proteinuria, gross and microscopic hematuria, and stabilization of renal function.
RESULTS: The 6 patients in this series had marked clinical and laboratory improvement of their nephropathy.
CONCLUSIONS: In a select group of pediatric cases of IgAN with mild to moderate disease and recurrent tonsillitis, tonsillectomy can be a useful adjuvant treatment to improve urinary symptoms and renal function. IgA nephropathy is a common indication for tonsillectomy in Japan but is seen less often in the United States. Otolaryngologists should be aware of this indication for tonsillectomy.
PMID: 19153312 [PubMed – indexed for MEDLINE]

 

Tonsillectomy has beneficial effects on remission and progression of IgA nephropathy independent of steroid therapy
Isseki Maeda1,2, Tomoshige Hayashi1, Kyoko Kogawa Sato1, Mikiko Okumoto Shibata2, Masahiro Hamada2, Masatsugu Kishida2, Chizuko Kitabayashi2, Takashi Morikawa2, Noriyuki Okada2, Michiaki Okumura2, Masayo Konishi3, Yoshio Konishi2, Ginji Endo1 and Masahito Imanishi2
+ Author Affiliations

1Department of Preventive Medicine and Environmental Health, Osaka City University Graduate School of Medicine, Osaka, Japan
2Department of Nephrology and Hypertension, Osaka City General Hospital, Osaka, Japan
3Department of Nephrology, Wakakusa Daiichi Hospital, Osaka, Japan
Correspondence and offprint requests to: Tomoshige Hayashi; E-mail: thayashi@med.osaka-cu.ac.jp
Received July 22, 2011.
Accepted February 2, 2012.
Abstract

Background. Indication of tonsillectomy in IgA nephropathy is controversial. The purpose of this study was to examine the efficacy of tonsillectomy on remission and progression of IgA nephropathy.

Methods. We conducted a single-center 7-year historical cohort study in 200 patients with biopsy-proven IgA nephropathy. Study outcomes were clinical remission defined as disappearance of urine abnormalities at two consecutive visits, glomerular filtration rate (GFR) decline defined as 30% GFR decrease from baseline and GFR slope during the follow-up.

Results. Seventy of the 200 patients received tonsillectomy. Tonsillectomy was associated with increased incidence of clinical remission (P < 0.01, log-rank test) and decreased incidence of GFR decline (P = 0.01, log-rank test). After adjustment for age and gender, hazard ratios in tonsillectomy were 3.90 (95% confidence interval 2.46–6.18) for clinical remission and 0.14 (0.02–1.03) for GFR decline. After further adjustment for laboratory (baseline mean arterial pressure, GFR, 24-h proteinuria and hematuria score), histological (mesangial score, segmental sclerosis or adhesion, endocapillary proliferation and interstitial fibrosis) or treatment variables (steroid and renin–angiotensin system inhibitors), similar results were obtained in each model. Even after exclusion of 69 steroid-treated patients, results did not change. GFR slopes in tonsillectomy and non-tonsillectomy groups were 0.60 ± 3.65 and −1.64 ± 2.59 mL/min/1.73 m2/year, respectively. In the multiple regression model, tonsillectomy prevented GFR decline during the follow-up period (regression coefficient 2.00, P = 0.01).

Conclusion. Tonsillectomy was associated with a favorable renal outcome of IgA nephropathy in terms of clinical remission and delayed renal deterioration even in non-steroid-treated patients.

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