Tonsillectomy and steroid pulse therapy significantly impact on clinical remission in patients with IgA nephropathy

We conducted a retrospective investigation of renal outcome in 329 patients with immunoglobulin A (IgA) nephropathy with an observation period longer than 36 months (82.3 +/- 38.2 months) in our renal unit between 1977 and 19 95. Clinical remission, renal progression, and the impact of covariates wer e estimated by Kaplan-Meier analysis and a Cox regression model. In 157 of 329 patients (48%), disappearance of urinary abnormalities (clinical remiss ion) was obtained. None of these 157 patients showed progressive deteriorat ion, defined as a 50% Increase in serum creatinine (Scr) level from baselin e, during the observation period. Conversely, in patients without clinical remission, the Kaplan-Meier estimate of probability of progressive deterior ation was 21% +/- 5% at 10 years. In the multivariate Cox regression model with 13 independent covariates, initial Scr level, histological score, tons illectomy, and high-dose methylprednisolone therapy had a significant impac t on clinical remission, whereas proteinuria, age, sex, levels of hematuria , blood pressure, conventional steroid therapy, angiotensin-converting enzy me inhibitor therapy, and cyclophosphamide therapy had no significant effec t. These findings Indicate that interventions aimed at achieving clinical r emission have provided encouraging results applicable to managing patients with IgA nephropathy. (C) 2001 by the National Kidney Foundation, Inc.