Pathological sub-analysis of a multicenter randomized controlled trial of tonsillectomy combined with steroid pulse therapy versus steroid pulse monotherapy in patients with immunoglobulin A nephropathy

Ritsuko Katafuchi, Tetsuya Kawamura, Kensuke Joh, Akinori Hashiguchi, Satoshi Hisano, Akira Shimizu, Yoichi Miyazaki, Masaharu Nagata, Seiichi Matsuo, Iga Nephropathy Study Group In Japan The Iga Nephropathy Study Group In Japan

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Background: The IgA nephropathy (IgAN) Study Group in Japan conducted a multicenter, randomized, controlled trial of tonsillectomy with steroid pulse therapy (TSP) versus steroid pulse monotherapy in patients with IgAN (UMIN Clinical Trial Registry Number; C000000384). The effects of therapies in relation to pathological severity were analyzed in this study. Methods: The patients with IgAN, urinary protein 1.0–3.5 g/day, serum creatinine of 1.5 mg/dl or less were randomly assigned to receiving TSP (Group A) or steroid pulses alone (Group B). The primary endpoint was the disappearance of proteinuria and/or hematuria. Twenty-six biopsies in Group A and 33 in Group B were available. The histological grades (HG) according to the percentage of glomeruli with crescent or sclerosis and the Oxford classification were analyzed. Results: The patients in Group A had a 4.32- to 12.1-fold greater benefit of disappearance of proteinuria and 3.61- to 8.17-fold greater benefit of clinical remission (disappearance of proteinuria and hematuria) than those in Group B in patients with HG2–3, acute lesions (cellular or fibrocellular crescent) affecting more than 5 % of glomeruli, chronic lesions (fibrous crescents or sclerosis) affecting more than 20 % and S1. In contrast, odds ratios for disappearance of proteinuria or clinical remission in Group A to Group B were not significant in patients with HG 1, acute lesion in 5 % or less of glomeruli, chronic lesion in 20 % or less and S0. The disappearance of hematuria showed no relation to pathological severity. Conclusion: TSP might be better employed according to the pathological severity.

Original languageEnglish
JournalClinical and Experimental Nephrology
DOIs
Publication statusAccepted/In press - 2015 Sep 9

Fingerprint

IGA Glomerulonephritis
Tonsillectomy
Proteinuria
Randomized Controlled Trials
Steroids
Hematuria
Immunoglobulin A
Sclerosis
Therapeutics
Registries
Creatinine
Japan
Odds Ratio
Clinical Trials
Biopsy
Serum
Proteins

Keywords

  • IgA nephropathy
  • Pathology
  • Randomized controlled trial
  • Steroid pulse therapy
  • Tonsillectomy

ASJC Scopus subject areas

  • Nephrology
  • Physiology
  • Physiology (medical)

Cite this

Pathological sub-analysis of a multicenter randomized controlled trial of tonsillectomy combined with steroid pulse therapy versus steroid pulse monotherapy in patients with immunoglobulin A nephropathy. / Katafuchi, Ritsuko; Kawamura, Tetsuya; Joh, Kensuke; Hashiguchi, Akinori; Hisano, Satoshi; Shimizu, Akira; Miyazaki, Yoichi; Nagata, Masaharu; Matsuo, Seiichi; The Iga Nephropathy Study Group In Japan, Iga Nephropathy Study Group In Japan.

In: Clinical and Experimental Nephrology, 09.09.2015.

Research output: Contribution to journalArticle

Katafuchi, Ritsuko ; Kawamura, Tetsuya ; Joh, Kensuke ; Hashiguchi, Akinori ; Hisano, Satoshi ; Shimizu, Akira ; Miyazaki, Yoichi ; Nagata, Masaharu ; Matsuo, Seiichi ; The Iga Nephropathy Study Group In Japan, Iga Nephropathy Study Group In Japan. / Pathological sub-analysis of a multicenter randomized controlled trial of tonsillectomy combined with steroid pulse therapy versus steroid pulse monotherapy in patients with immunoglobulin A nephropathy. In: Clinical and Experimental Nephrology. 2015.
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abstract = "Background: The IgA nephropathy (IgAN) Study Group in Japan conducted a multicenter, randomized, controlled trial of tonsillectomy with steroid pulse therapy (TSP) versus steroid pulse monotherapy in patients with IgAN (UMIN Clinical Trial Registry Number; C000000384). The effects of therapies in relation to pathological severity were analyzed in this study. Methods: The patients with IgAN, urinary protein 1.0–3.5 g/day, serum creatinine of 1.5 mg/dl or less were randomly assigned to receiving TSP (Group A) or steroid pulses alone (Group B). The primary endpoint was the disappearance of proteinuria and/or hematuria. Twenty-six biopsies in Group A and 33 in Group B were available. The histological grades (HG) according to the percentage of glomeruli with crescent or sclerosis and the Oxford classification were analyzed. Results: The patients in Group A had a 4.32- to 12.1-fold greater benefit of disappearance of proteinuria and 3.61- to 8.17-fold greater benefit of clinical remission (disappearance of proteinuria and hematuria) than those in Group B in patients with HG2–3, acute lesions (cellular or fibrocellular crescent) affecting more than 5 {\%} of glomeruli, chronic lesions (fibrous crescents or sclerosis) affecting more than 20 {\%} and S1. In contrast, odds ratios for disappearance of proteinuria or clinical remission in Group A to Group B were not significant in patients with HG 1, acute lesion in 5 {\%} or less of glomeruli, chronic lesion in 20 {\%} or less and S0. The disappearance of hematuria showed no relation to pathological severity. Conclusion: TSP might be better employed according to the pathological severity.",
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T1 - Pathological sub-analysis of a multicenter randomized controlled trial of tonsillectomy combined with steroid pulse therapy versus steroid pulse monotherapy in patients with immunoglobulin A nephropathy

AU - Katafuchi, Ritsuko

AU - Kawamura, Tetsuya

AU - Joh, Kensuke

AU - Hashiguchi, Akinori

AU - Hisano, Satoshi

AU - Shimizu, Akira

AU - Miyazaki, Yoichi

AU - Nagata, Masaharu

AU - Matsuo, Seiichi

AU - The Iga Nephropathy Study Group In Japan, Iga Nephropathy Study Group In Japan

PY - 2015/9/9

Y1 - 2015/9/9

N2 - Background: The IgA nephropathy (IgAN) Study Group in Japan conducted a multicenter, randomized, controlled trial of tonsillectomy with steroid pulse therapy (TSP) versus steroid pulse monotherapy in patients with IgAN (UMIN Clinical Trial Registry Number; C000000384). The effects of therapies in relation to pathological severity were analyzed in this study. Methods: The patients with IgAN, urinary protein 1.0–3.5 g/day, serum creatinine of 1.5 mg/dl or less were randomly assigned to receiving TSP (Group A) or steroid pulses alone (Group B). The primary endpoint was the disappearance of proteinuria and/or hematuria. Twenty-six biopsies in Group A and 33 in Group B were available. The histological grades (HG) according to the percentage of glomeruli with crescent or sclerosis and the Oxford classification were analyzed. Results: The patients in Group A had a 4.32- to 12.1-fold greater benefit of disappearance of proteinuria and 3.61- to 8.17-fold greater benefit of clinical remission (disappearance of proteinuria and hematuria) than those in Group B in patients with HG2–3, acute lesions (cellular or fibrocellular crescent) affecting more than 5 % of glomeruli, chronic lesions (fibrous crescents or sclerosis) affecting more than 20 % and S1. In contrast, odds ratios for disappearance of proteinuria or clinical remission in Group A to Group B were not significant in patients with HG 1, acute lesion in 5 % or less of glomeruli, chronic lesion in 20 % or less and S0. The disappearance of hematuria showed no relation to pathological severity. Conclusion: TSP might be better employed according to the pathological severity.

AB - Background: The IgA nephropathy (IgAN) Study Group in Japan conducted a multicenter, randomized, controlled trial of tonsillectomy with steroid pulse therapy (TSP) versus steroid pulse monotherapy in patients with IgAN (UMIN Clinical Trial Registry Number; C000000384). The effects of therapies in relation to pathological severity were analyzed in this study. Methods: The patients with IgAN, urinary protein 1.0–3.5 g/day, serum creatinine of 1.5 mg/dl or less were randomly assigned to receiving TSP (Group A) or steroid pulses alone (Group B). The primary endpoint was the disappearance of proteinuria and/or hematuria. Twenty-six biopsies in Group A and 33 in Group B were available. The histological grades (HG) according to the percentage of glomeruli with crescent or sclerosis and the Oxford classification were analyzed. Results: The patients in Group A had a 4.32- to 12.1-fold greater benefit of disappearance of proteinuria and 3.61- to 8.17-fold greater benefit of clinical remission (disappearance of proteinuria and hematuria) than those in Group B in patients with HG2–3, acute lesions (cellular or fibrocellular crescent) affecting more than 5 % of glomeruli, chronic lesions (fibrous crescents or sclerosis) affecting more than 20 % and S1. In contrast, odds ratios for disappearance of proteinuria or clinical remission in Group A to Group B were not significant in patients with HG 1, acute lesion in 5 % or less of glomeruli, chronic lesion in 20 % or less and S0. The disappearance of hematuria showed no relation to pathological severity. Conclusion: TSP might be better employed according to the pathological severity.

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KW - Pathology

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KW - Steroid pulse therapy

KW - Tonsillectomy

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