Efficacy and safety of tonsillectomy combined with steroid pulse therapy for IgA nephropathy with mild proteinuria

Abstract

Background and Purpose: Although clinical practice guidelines recommend that angiotensin system (RAS) inhibitors be considered for children with mild IgA nephropathy, the spontaneous remission rate of IgA nephropathy in children with mild proteinuria is not high, around 20%. Methods: In this retrospective study, we investigated the efficacy and safety of tonsillectomy combined with steroid pulse therapy as initial treatment in 59 children (median age, 13.0 years) with IgA nephropathy and mild proteinuria (urinary protein/creatinine ratio, <1.0 g/gCr). Results: After the initiation of steroid pulse therapy, proteinuria disappeared in 57 patients (97%) at a median of 8.0 days; hematuria disappeared in 57 patients (97%) at a median of 6.8 months. During the follow-up period (median, 6.0 years), relapse occurred in three patients (5%). However, there were no serious adverse events due to steroid pulse therapy or tonsillectomy. At the last follow-up (median age 18.3 years), one patient (2%) had mild proteinuria and six patients (10%) had hematuria. Although one patient received RAS inhibitors, none developed CKD stage 3 or higher. Conclusion: Tonsillectomy combined with steroid pulse therapy should be considered as initial therapy in children with undeniable future progression to CKD.