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Long‐term follow up of pediatric immunoglobulin A nephropathy treated with tonsillectomy plus methylprednisolone pulse therapy
Author(s) -
Kawasaki Yukihiko,
Maeda Ryo,
Kanno Shuto,
Suzuki Yuichi,
Ohara Shinichiro,
Suyama Kazuhide,
Hosoya Mitsuaki
Publication year - 2017
Publication title -
pediatrics international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.49
H-Index - 63
eISSN - 1442-200X
pISSN - 1328-8067
DOI - 10.1111/ped.13074
Subject(s) - medicine , tonsillectomy , nephropathy , urinary system , renal function , creatinine , methylprednisolone , gastroenterology , surgery , incidence (geometry) , glomerulonephritis , urine , urology , kidney , endocrinology , physics , optics , diabetes mellitus
Background The aim of this study was to clarify the long‐term efficacy of tonsillectomy plus methylprednisolone pulse therapy (tonsillectomy pulse therapy [TMP]) for pediatric immunoglobulin A nephropathy (IgAN). The clinical and laboratory findings as well as the prognosis for IgAN treated with TMP at long‐term follow up were evaluated. Methods We collected data on 33 IgAN children treated with TMP. The children were retrospectively divided into two groups. Group 1 consisted of 18 children treated with TMP as the initial therapy, and group 2 consisted of 15 children treated with TMP as rescue therapy for IgAN relapse. The clinical features, and laboratory and pathological findings, including those at first and second renal biopsy as well as at the latest follow up, were analyzed for both groups. Results Mean urinary protein excretion, incidence of hematuria, and serum creatinine in groups 1 and 2 were all decreased significantly after TMP compared with beforehand. The percentage of glomeruli showing crescents after TMP in groups 1 and 2 was significantly lower than before TMP. At the most recent follow up, 94% of patients in group 1 and 87% in group 2 had normal urine, 6% in group 1 and 13% in group 2 had minor urinary abnormalities, and no patients in either group had active renal disease or renal insufficiency. Conclusions TMP is effective in ameliorating urinary abnormalities and improving the long‐term outcome of pediatric IgAN both as an initial and as a rescue treatment.