Comparison of effective impact among tonsillectomy alone, tonsillectomy combined with oral steroid and with steroid pulse therapy on long-term outcome of immunoglobulin A nephropathy
Autor: | Makoto Tomita, Kazuo Takahashi, Koichiro Yamamoto, Yukio Yuzawa, Shiro Kawashima, Midori Hasegawa, Yoshiyuki Hiki, Shigehisa Koide, Kazutaka Murakami, Yoshihiro Yamamoto, Shigeru Nakai, Satoshi Sugiyama |
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Rok vydání: | 2012 |
Předmět: |
Adult
Male Nephrology medicine.medical_specialty Physiology medicine.medical_treatment Anti-Inflammatory Agents Kidney Function Tests urologic and male genital diseases Risk Assessment Steroid Renal Dialysis Risk Factors Physiology (medical) Internal medicine medicine Humans Renal Insufficiency Immunoglobulin A Nephropathy Tonsillectomy Proportional Hazards Models Retrospective Studies business.industry Steroid therapy Glomerulonephritis IGA IgA nephropathy Middle Aged Prognosis Combined Modality Therapy Glomerular Mesangium Immunoglobulin A Treatment Treatment Outcome Creatinine Steroid pulse Oral steroid Regression Analysis Original Article Female Steroids business Follow-Up Studies |
Zdroj: | Clinical and Experimental Nephrology |
ISSN: | 1437-7799 1342-1751 |
Popis: | Background To clarify the therapeutic impact of tonsillectomy and combined therapies of tonsillectomy plus steroid on the long-term prognosis of immunoglobulin A nephropathy (IgAN). Methods A retrospective study was conducted on 208 patients with IgAN between 1986 and 2009. According to the strategies for treatments, patients were divided into four groups: tonsillectomy and steroid pulse (TSP, n = 47), tonsillectomy and oral steroid (TOS, n = 33), tonsillectomy alone (T, n = 56), and N group (no particular therapy, n = 72). Multivariate analysis based on the Cox’s regression model was used to assess the relative risk of reaching the outcome of doubling creatinine based on the influence of baseline prognostic factors. Results The mean observation periods were 53.8 months in the TSP group, 122.0 months in the TOS group, 102.9 months in the T group, and 84.6 months in the N group. During an observation period, serum creatinine levels doubled as follows: one in the TSP group (2.1 %), two in the TOS group (6.1 %), five in the T group (8.9 %), histological severity, and 22 in the N group (30.6 %). The Cox’s regression proportional hazard model showed that gender, age, histological activity, dialysis induction risk and therapy were associated with doubling creatinine levels. Hazard ratios (95 % CI) and (P value) in T, TOS, and TSP groups versus N were 0.314 (0.11–0.93, P = 0.037), 0.213 (0.04–1.10, P = 0.065), and 0.032 (0.00–0.28, P = 0.002), respectively. Conclusion A combination therapy of tonsillectomy and steroid pulse had the most significant therapeutic impact compared to other therapies. |
Databáze: | OpenAIRE |
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