Tonsillectomy For IgAN – Recent Papers

Here is a collection of papers from NIH’s PubMed service that all support the use of tonsillectomy for treatment of IgAN

*******************
Int Urol Nephrol. 2014 Sep 3. [Epub ahead of print]

Effect of tonsillectomy and its timing on renal outcomes in Caucasian IgA nephropathy patients.

Abstract

PURPOSE:

The role of tonsillectomy in the treatment of IgA nephropathy in Caucasian patients is controversial.

METHODS:

A retrospective cohort study was conducted in 264 patients with biopsy-proven primary IgA nephropathy to examine the association between tonsillectomy and long-term renal survival, defined as the incidence of estimated glomerular filtration rates (eGFRs) of ≤30 ml/min/1.73 m2 or end-stage renal disease (the composite of initiation of dialysis treatment or renal transplantation). The association of tonsillectomy with renal end-points was examined using the Kaplan-Meier method and Cox models.

RESULTS:

One-hundred and sixty-six patients did not undergo tonsillectomy (Group I, follow-up 130 ± 101 months) and 98 patients underwent tonsillectomy (Group II, follow-up 170 ± 124 months). The mean renal survival time was significantly longer for both end-points between those patients who underwent tonsillectomy (Group II) versus patients without tonsillectomy (Group I) (p < 0.001 and p = 0.005). The mean renal survival time was significantly longer for both end-points between those patients who had macrohaematuric episodes versus patients who had no macrohaematuric episodes (p = 0.035 and p = 0.019). Tonsillectomy, baseline eGFR and 24-h proteinuria were independent risk factors for both renal end-points.

*******************

Int J Otolaryngol. 2014;2014:451612. doi: 10.1155/2014/451612. Epub 2014 May 19.

The Relationship between the Efficacy of Tonsillectomy and Renal Pathology in the Patients with IgA Nephropathy.

Abstract

Objective. The aim of this study was to evaluate the effects of tonsillectomy as a treatment for IgA nephropathy in relation to renal pathological findings. Methods. This is a retrospective analysis of 13 patients having IgA nephropathy treated by tonsillectomy. Results. UP/UCre levels decreased from 820.8 to 585.4 one month postsurgery and then showed slight worsening to 637.3 at the most recent follow-up. There was no significant difference in the improvement rate between pathological grades I-III and IV. There was positive correlation between Pre-UP/UCre level and the reduction rate of UP/UCre, which was statistically significant (R = 0.667, R (2) = 0.445, and P = 0.01). Conclusions. Reduction of UP/UCre at one month postsurgery is considered to be an overall prognostic factor, and tonsillectomy is considered to be an effective therapy for IgA patients regardless of the grade of renal pathology.

PMID:
24959178
[PubMed]
PMCID:
PMC4052205

Free PMC Article

CONCLUSION:

Tonsillectomy may delay the progression of IgA nephropathy mainly in IgA nephropathy patients with macrohaematuria. Prospective investigation of the protective role of tonsillectomy in Caucasian patients is needed.

*******************

PLoS One. 2014 Mar 21;9(3):e91756. doi: 10.1371/journal.pone.0091756. eCollection 2014.

Prognosis in IgA nephropathy: 30-year analysis of 1,012 patients at a single center in Japan.

Abstract

BACKGROUND:

Little is known about the long-term prognosis of patients with IgA nephropathy (IgAN).

METHODS:

This retrospective cohort analysis evaluated clinical and histological findings at the time of renal biopsy, initial treatment, patient outcomes over 30 years, and risk factors associated with progression in 1,012 patients diagnosed with IgAN at our center since 1974.

RESULTS:

Of the 1,012 patients, 40.5% were male. Mean patient age was 33±12 years and mean blood pressure was 122±17/75±13 mmHg. Mean serum creatinine concentration was 0.89±0.42 mg/dL, and mean estimated glomerular filtration rate (eGFR) was 78.5±26.2 ml/min/1.73 m2. Mean proteinuria was 1.19±1.61 g/day, and mean urinary red blood cells were 36.6±35.3/high-powered field. Histologically, mesangial hypercellularity was present in 47.6% of patients, endothelial hypercellularity in 44.3%, segmental sclerosis in 74.6%, and tubular atrophy/interstitial fibrosis in 28.8% by Oxford classification. Initial treatment consisted of corticosteroids in 26.9% of patients, renin-angiotensin-aldosterone system inhibitor in 28.9%, andtonsillectomy plus steroids in 11.7%. The 10-, 20-, and 30-year renal survival rates were 84.3, 66.6, and 50.3%, respectively. Tonsillectomy plus steroids dramatically improved renal outcome. Cox multivariate regression analysis showed that higher proteinuria, lower eGFR, and higher uric acid at the time of renal biopsy were independent risk factors for the development of end stage renal disease (ESRD).

CONCLUSIONS:

IgAN is not a benign disease, with about 50% of patients progressing to ESRD within 30 years despite treatment.

PMID:
24658533
[PubMed – in process]
PMCID:
PMC3962373

Free PMC Article

*******************
Hum Immunol. 2013 Jun;74(6):708-12. doi: 10.1016/j.humimm.2012.10.028. Epub 2013 Jan 8.

The role of memory B cell in tonsil and peripheral blood in the clinical progression of IgA nephropathy.

Abstract

BACKGROUND:

B cells in tonsil, which may produce the nephritogenic IgA, have been incriminated in the pathogenesis of IgAN. The aim of the present study was to assess the role of memory B cell in clinical progression of IgAN. Methods we investigated 28 IgAN patients and 27 age-matched patients with chronic tonsillitis without IgAN, who were treated by tonsillectomy, meanwhile, the peripheral blood (PB) of 10 healthy individuals were also as control groups. In tonsil and PB, the frequency of memory B cells were tested by Flow cytometric (FCM).

RESULTS:

In this study, higher percentage of memory B cells were observed in tonsil and PB of IgAN patients. After tonsillectomy, the percentage of memory B cells in IgAN patients were significantly (P<0.05) lower than before tonsillectomy. Meanwhile, in tonsil and PB, the percentage of memory B cells variated with the variation of urinary finding of IgAN patients.

CONCLUSIONS:

The percentage of memory B cell in tonsil and PB could predict disease progression of IgAN to a certain extend; it’s variation in pre- and post- tonsillectomy can provide theoretical basis to cure IgAN patients indirectly.

Copyright © 2013. Published by Elsevier Inc.

PMID:
23313256
[PubMed – indexed for MEDLINE]
*******************
Otolaryngol Head Neck Surg. 2014 Apr;150(4):574-81. doi: 10.1177/0194599813519972.

Prevalence of complications from adult tonsillectomy and impact on health care expenditures.

Abstract

OBJECTIVE:

To provide information on the prevalence of common complications of adult tonsillectomy and associated health care utilization and expenditures.

STUDY DESIGN:

Retrospective analysis of a large insurance database.

SETTING:

Data from the MarketScan Commercial Claims and Encounters Database.

SUBJECTS AND METHODS:

Treated prevalence rates for post-tonsillectomy complications were calculated for 36,210 patients with employer-sponsored insurance who had an outpatient tonsillectomy between 2002 and 2007. The relationships with various patient characteristics were examined using multivariate logistic regression. Postoperative emergency department (ED) visits and hospitalizations and total per capita health care expenditures were analyzed.

RESULTS:

This analysis suggests that of adult patients who undergo a tonsillectomy, 20% will have a complication, 10% will visit an ED, and approximately 1.5% will be admitted to a hospital within 14 days of the tonsillectomy. Six percent were treated for postoperative hemorrhage, 2% for dehydration, and 11% for ENT pain within 14 days of surgery. Patients with comorbidities, prior peritonsillar abscess, or an increased number of antibiotic prescriptions in the past year were significantly more likely to develop complications. Three out of 4 patients with postoperative hemorrhage went to the ED (4.63% of all patients), and 50% had a procedural intervention (3.09% overall). The average cost associated with a tonsillectomy was $3832 if no complication. If there was a complication within 14 days, hemorrhage was the most expensive ($6388 vs $5753 for dehydration and $4708 for ENT pain).

CONCLUSIONS:

Complications of adult outpatient tonsillectomies are common and may be associated with significant morbidity, health care utilization, and expenditures.

KEYWORDS:

complication; outpatient surgery; tonsillectomy

PMID:
24691645
[PubMed – indexed for MEDLINE]

Related Post