Efficacy and indications of tonsillectomy in patients with IgA nephropathy: a retrospective study

Yan Li; Qi Wan; Zhixin Lan; Ming Xia; Haiyang Liu; Guochun Chen; Liyu He; Chang Wang; Hong Liu

doi:10.7717/peerj.14481

Efficacy and indications of tonsillectomy in patients with IgA nephropathy: a retrospective study

PeerJ. 2022 Dec 5:10:e14481. doi: 10.7717/peerj.14481. eCollection 2022.

Authors

Yan Li¹, Qi Wan², Zhixin Lan³, Ming Xia³, Haiyang Liu³, Guochun Chen³, Liyu He³, Chang Wang³, Hong Liu³

Affiliations

¹ Department of Nephrology, Hunan Provincial People's Hospital, Hunan Normal University, Changsha, Hunan, China.
² Department of Orthopedic Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China.
³ Department of Nephrology, The Second Xiangya Hospital, Central South University, Hunan Key Laboratory of Kidney Disease and Blood Purification, Changsha, Hunan, China.

Abstract

Background: The efficacy and indications of tonsillectomy in IgA nephropathy (IgAN) remain uncertain.

Methods: We performed a retrospective cohort study of 452 patients with primary IgAN, including 226 patients who received tonsillectomy and 226 controls selected by propensity score matching who had never undergone tonsillectomy. Study outcomes were clinical remission defined as negative hematuria and proteinuria on three consecutive visits over a 6-month period, the endpoint defined as end-stage renal disease or an irreversible 100% increase in serum creatinine from the baseline value. In addition, we further analyzed the critical level of proteinuria in the efficacy of tonsillectomy and the correlation between MEST-C score and tonsillectomy.

Results: Up to December 2019, the follow-up period lasted 46 ± 23 months (12-106 months). Kaplan-Meier and multivariate Cox regression analysis revealed that tonsillectomy was beneficial for clinical remission and renal survival. Whether proteinuria was ≤ 1 g/24h or >1 g/24h, the clinical remission and renal survival rates were greater in patients treated with tonsillectomy than without. When the pathological damage was mild or relatively severe, tonsillectomy may be beneficial to clinical remission or renal survival.

Conclusions: Tonsillectomy had a favorable effect on clinical remission and delayed renal deterioration in IgAN. In addition to patients with early stage IgAN, it may also be beneficial to IgAN patients with higher levels of proteinuria and relatively severe pathological damage.

Keywords: Clinical remission; IgA nephropathy; Indication; Renal survival; Tonsillectomy.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Glomerulonephritis, IGA* / complications
Humans
Kidney / pathology
Proteinuria / etiology
Retrospective Studies
Tonsillectomy*

Grants and funding

This work was supported by the National Natural Science Foundation of China (No. 82070737) and the Research Foundation of Jiangxi Provincial Education Department (No. GJJ200224). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.