Background: Tonsillectomy has been considered a treatment for IgA nephropathy (IgAN). It is aimed at removing a source of pathogens, reducing mucosa-associated lymphoid tissue and decreasing polymeric IgA synthesis. However, its beneficial effect is still controversial. In Asia, favorable outcomes have been claimed mostly in association with corticosteroids. In Europe, small, single-center uncontrolled studies have failed to show benefits. Methods: The European validation study of the Oxford classification of IgAN (VALIGA) collected data from 1,147 patients with IgAN over a follow-up of 4.7 years. We investigated the outcome of progression to end-stage renal disease (ESRD) and/or 50% loss of estimated glomerular filtration rate (eGFR) and the annual loss of eGFR in 61 patients who had had tonsillectomy. Results: Using the propensity score, which is a logistic regression model, we paired 41 patients with tonsillectomy and 41 without tonsillectomy with similar risk of progression (gender, age, race, mean blood pressure, proteinuria, eGFR at renal biopsy, previous treatments and Oxford MEST scores). No significant difference was found in the outcome. Moreover, we performed an additional propensity score pairing 17 patients who underwent tonsillectomy after the diagnosis of IgAN and 51 without tonsillectomy with similar risk of progression at renal biopsy and subsequent treatments. No significant difference was found in changes in proteinuria, or in the renal end point of 50% reduction in GFR and/or ESRD, or in the annual loss of eGFR. Conclusion: In the large VALIGA cohort of European subjects with IgAN, no significant correlation was found between tonsillectomy and renal function decline.

Tonsillectomy in a European Cohort of 1,147 Patients with IgA Nephropathy / Feehally, J; Coppo, R; Troyanov, S; Bellur, Ss; Cattran, D; Cook, T; Roberts, Is; Verhave, Jc; Camilla, R; Vergano, L; Egido, J; Wiecek, A; Karkoszka, H; Tesar, V; Maixnerova, D; Ots Rosenberg, M; Quaglia, M; Rollino, C; Magistroni, R; Cusinato, S; Cravero, R; Lundberg, S; Gesualdo, L; Cancarini, G; Feriozzi, S; Ferrario, Franco; VALIGA study of the ERA EDTA Immunonephrology Working, Group; Tesar, V; Maixnerova, D; Lundberg, S; Gesualdo, L; Emma, F; Fuiano, L; Beltrame, G; Rollino, C; Coppo, R; Amore, A; Camilla, R; Vergano, L; Praga, M; Feriozzi, S; Polci, R; Biancone, L; Colla, Luigi; Pani, A; Angioi, A; Piras, D; Feehally, J; Cancarini, G; Ravera, S; Durlik, M; Moggia, E; Ballarin, J; Di Giulio, S; Pierucci, Alessandro; Caliskan, Y; Sever, M; Kilicaslan, I; Locatelli, F; Del Vecchio, L; Wetzels, Jf; Peters, H; Berg, U; Carvalho, F; da Costa Ferreira, Ac; Maggio, M; Wiecek, A; Karkoszka, H; Ots Rosenberg, M; Magistroni, R; Topaloglu, R; Bilginer, Y; D'Amico, M; Stangou, M; Giacchino, F; Goumenos, D; Kalliakmani, P; Gerolymos, M; Galesic, K; Geddes, C; Siamopoulos, K; Balafa, O; Galliani, M; Stratta, P; Bergia, R; Cravero, R; Salvadori, M; Cirami, L; Fellstrom, B; Kloster Smerud, H; Ferrario, F; Stellato, T; Egido, J; Cleary, C; Floege, J; Rauen, T; Lupo, A; Bernich, P; Mene', Paolo; Morosetti, M; van Kooten, C; Rabelink, T; Reinders, Me; Boria Grinyo, Jm; Cusinato, S; Benozzi, L; Savoldi, S; Licata, C; Mizerska Wasiak, M; Roszkowska Blaim, M; Martina, G; Messuerotti, A; Dal Canton, A; Esposito, C; Migotto, C; Triolo, G; Mariano, F; Pozzi, C; Di Palma, Am; Boero, R; Mazzucco, G; Giannakakis, Konstantinos; Honsova, E; Sundelin, B; Ferrario, F; Gutiérrez, E; Asunis, Am; Barratt, J; Tardanico, R; Perkowska Ptasinska, A; Arce Terroba, J; Fortunato, M; Pantzaki, A; Ozluk, Y; Steenbergen, E; Soderberg, M; Riispere, Z; Furci, L; Orhan, D; Kipgen, D; Casartelli, D; Galesic Ljubanovic, D; Gakiopoulou, H; Bertoni, E; Cannata Ortiz, P; Karkoszka, H; Groene, Hj; Stoppacciaro, A; Bajema, I; Bruijn, J; Fulladosa Oliveras, X; Maldyk, J; Ioachim, E.. - In: NEPHRON JOURNALS. - ISSN 1660-8151. - STAMPA. - 132:1(2016), pp. 15-24. [10.1159/000441852]

Tonsillectomy in a European Cohort of 1,147 Patients with IgA Nephropathy

COLLA, LUIGI;PIERUCCI, Alessandro;Locatelli, F;MENE', Paolo;GIANNAKAKIS, Konstantinos;Stoppacciaro, A;
2016

Abstract

Background: Tonsillectomy has been considered a treatment for IgA nephropathy (IgAN). It is aimed at removing a source of pathogens, reducing mucosa-associated lymphoid tissue and decreasing polymeric IgA synthesis. However, its beneficial effect is still controversial. In Asia, favorable outcomes have been claimed mostly in association with corticosteroids. In Europe, small, single-center uncontrolled studies have failed to show benefits. Methods: The European validation study of the Oxford classification of IgAN (VALIGA) collected data from 1,147 patients with IgAN over a follow-up of 4.7 years. We investigated the outcome of progression to end-stage renal disease (ESRD) and/or 50% loss of estimated glomerular filtration rate (eGFR) and the annual loss of eGFR in 61 patients who had had tonsillectomy. Results: Using the propensity score, which is a logistic regression model, we paired 41 patients with tonsillectomy and 41 without tonsillectomy with similar risk of progression (gender, age, race, mean blood pressure, proteinuria, eGFR at renal biopsy, previous treatments and Oxford MEST scores). No significant difference was found in the outcome. Moreover, we performed an additional propensity score pairing 17 patients who underwent tonsillectomy after the diagnosis of IgAN and 51 without tonsillectomy with similar risk of progression at renal biopsy and subsequent treatments. No significant difference was found in changes in proteinuria, or in the renal end point of 50% reduction in GFR and/or ESRD, or in the annual loss of eGFR. Conclusion: In the large VALIGA cohort of European subjects with IgAN, no significant correlation was found between tonsillectomy and renal function decline.
2016
iga nephropathy; tonsillectomy; risk factors; progression of chronic renal failure
01 Pubblicazione su rivista::01a Articolo in rivista
Tonsillectomy in a European Cohort of 1,147 Patients with IgA Nephropathy / Feehally, J; Coppo, R; Troyanov, S; Bellur, Ss; Cattran, D; Cook, T; Roberts, Is; Verhave, Jc; Camilla, R; Vergano, L; Egido, J; Wiecek, A; Karkoszka, H; Tesar, V; Maixnerova, D; Ots Rosenberg, M; Quaglia, M; Rollino, C; Magistroni, R; Cusinato, S; Cravero, R; Lundberg, S; Gesualdo, L; Cancarini, G; Feriozzi, S; Ferrario, Franco; VALIGA study of the ERA EDTA Immunonephrology Working, Group; Tesar, V; Maixnerova, D; Lundberg, S; Gesualdo, L; Emma, F; Fuiano, L; Beltrame, G; Rollino, C; Coppo, R; Amore, A; Camilla, R; Vergano, L; Praga, M; Feriozzi, S; Polci, R; Biancone, L; Colla, Luigi; Pani, A; Angioi, A; Piras, D; Feehally, J; Cancarini, G; Ravera, S; Durlik, M; Moggia, E; Ballarin, J; Di Giulio, S; Pierucci, Alessandro; Caliskan, Y; Sever, M; Kilicaslan, I; Locatelli, F; Del Vecchio, L; Wetzels, Jf; Peters, H; Berg, U; Carvalho, F; da Costa Ferreira, Ac; Maggio, M; Wiecek, A; Karkoszka, H; Ots Rosenberg, M; Magistroni, R; Topaloglu, R; Bilginer, Y; D'Amico, M; Stangou, M; Giacchino, F; Goumenos, D; Kalliakmani, P; Gerolymos, M; Galesic, K; Geddes, C; Siamopoulos, K; Balafa, O; Galliani, M; Stratta, P; Bergia, R; Cravero, R; Salvadori, M; Cirami, L; Fellstrom, B; Kloster Smerud, H; Ferrario, F; Stellato, T; Egido, J; Cleary, C; Floege, J; Rauen, T; Lupo, A; Bernich, P; Mene', Paolo; Morosetti, M; van Kooten, C; Rabelink, T; Reinders, Me; Boria Grinyo, Jm; Cusinato, S; Benozzi, L; Savoldi, S; Licata, C; Mizerska Wasiak, M; Roszkowska Blaim, M; Martina, G; Messuerotti, A; Dal Canton, A; Esposito, C; Migotto, C; Triolo, G; Mariano, F; Pozzi, C; Di Palma, Am; Boero, R; Mazzucco, G; Giannakakis, Konstantinos; Honsova, E; Sundelin, B; Ferrario, F; Gutiérrez, E; Asunis, Am; Barratt, J; Tardanico, R; Perkowska Ptasinska, A; Arce Terroba, J; Fortunato, M; Pantzaki, A; Ozluk, Y; Steenbergen, E; Soderberg, M; Riispere, Z; Furci, L; Orhan, D; Kipgen, D; Casartelli, D; Galesic Ljubanovic, D; Gakiopoulou, H; Bertoni, E; Cannata Ortiz, P; Karkoszka, H; Groene, Hj; Stoppacciaro, A; Bajema, I; Bruijn, J; Fulladosa Oliveras, X; Maldyk, J; Ioachim, E.. - In: NEPHRON JOURNALS. - ISSN 1660-8151. - STAMPA. - 132:1(2016), pp. 15-24. [10.1159/000441852]
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