Document Detail


Clinical effectiveness of steroid pulse therapy combined with tonsillectomy in patients with immunoglobulin A nephropathy presenting glomerular haematuria and minimal proteinuria.
MedLine Citation:
PMID:  20377779     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
AIM: The effectiveness of steroid pulse therapy combined with tonsillectomy (ST) has been shown in immunoglobulin A nephropathy (IgAN) patients with moderate or severe urinary abnormalities. The present study aimed to clarify whether the effectiveness may be extrapolated to IgAN with minor urinary abnormalities, and whether the effectiveness may depend on the histological severity with minor urinary abnormalities. METHODS: Data on 388 IgAN patients diagnosed by renal biopsies between 1987 and 2000 in Sendai Shakaihoken Hospital, who presented glomerular haematuria and minimal proteinuria (<or=0.5 g/day) at baseline, were analyzed. Cox regression was used to examine associations between baseline use of ST and subsequent clinical remission (CR), defined as negative proteinuria by dipstick and urinary erythrocytes of less than 1/high-power field. The instrumental variable method was also used to overcome confounding by treatment indication. RESULTS: During a median follow up of 24 months, we observed 170 CR cases. Patients receiving ST were younger and showed a better case-mix profile. Patients with ST had a significantly higher rate of CR than patients without tonsillectomy or steroid pulse in an unadjusted (hazard ratio (HR) = 5.51, 95% confidence interval (CI) = 3.33-9.12, P < 0.001) or adjusted Cox model (HR = 4.65, 95% CI = 2.43-8.88, P < 0.001). Less severe histological findings were substantially associated with higher CR rate in ST group. Adjusting for confounding by treatment indication showed an attenuated but still significant effect of ST (HR = 3.10, 95% CI = 2.02-4.77, P < 0.001). CONCLUSION: ST significantly increased the probability of CR in IgAN patients with glomerular haematuria and minimal proteinuria, and it was more effective in those with less severe histological findings.
Authors:
Takehiko Kawaguchi; Norio Ieiri; Shin Yamazaki; Yasuaki Hayashino; Brenda Gillespie; Mariko Miyazaki; Yoshio Taguma; Shunichi Fukuhara; Osamu Hotta
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Nephrology (Carlton, Vic.)     Volume:  15     ISSN:  1440-1797     ISO Abbreviation:  Nephrology (Carlton)     Publication Date:  2010 Feb 
Date Detail:
Created Date:  2010-04-09     Completed Date:  2010-08-03     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9615568     Medline TA:  Nephrology (Carlton)     Country:  Australia    
Other Details:
Languages:  eng     Pagination:  116-23     Citation Subset:  IM    
Affiliation:
Department of Epidemiology and Healthcare Research, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan. kawatake45@gmail.com
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Aged
Combined Modality Therapy
Female
Glomerulonephritis, IGA / complications*,  therapy*
Glucocorticoids / administration & dosage*
Hematuria / etiology*,  therapy*
Humans
Male
Methylprednisolone / administration & dosage*
Middle Aged
Prednisolone / administration & dosage*
Proteinuria / etiology*,  therapy*
Pulse Therapy, Drug
Remission Induction
Retrospective Studies
Tonsillectomy*
Young Adult
Chemical
Reg. No./Substance:
0/Glucocorticoids; 50-24-8/Prednisolone; 83-43-2/Methylprednisolone

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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