Tonsillectomy and immunosuppression improve outcomes in Caucasians with high-risk IgA nephropathy

Considering the absence of such data, this study explored the effectiveness of immunosuppressive therapy (IST) and tonsillectomy (TE) in Caucasians with high-risk immunoglobulin A nephropathy (IgAN).

The prospective non-randomised comparative study enrolled incident Caucasian patients with a definite clinical and histological diagnosis of primary IgAN (n = 221, age 35 ± 11 years, 52% male) at high risk of progression. All patients received IST (72.3% glucocorticoid monotherapy) without TE (control group, n = 136) or with TE (TE + IST; experimental group, n = 85). The median follow-up period was 33 months (interquartile range 15-69). Kaplan-Meier and Cox regression analyses combined with pseudo-randomisation methods (1:1 matching of comparison groups) and inverse probability of treatment weighting (IPTW) were applied to assess the effects of TE + IST on primary outcomes: complete remission (CR), overall (complete or partial) remission (OR) and disease progression (>40% decrease in estimated glomerular filtration rate or end-stage kidney disease).

The rates of early OR in the IST and TE + IST groups were 72.6% and 95.2%, respectively (P < .001). In the Kaplan-Meier analyses, the time to remission was 2-fold shorter in the TE + IST group (P < .001). In the adjusted Cox models, the probabilities of early OR and CR were significantly higher in the tonsillectomy group compared with IST alone {hazard ratio [HR] 3.364 [95% confidence interval (CI) 2.302-4.917] and HR 6.315 [95% CI 2.620-15.224], respectively}. The disease progression was registered in 3 patients (3.5%) in those on the combination therapy compared with 39 patients (28.9%) in the IST group [adjusted HR 0.126 (95% CI 0.037-0.427)]. Analyses performed in propensity score 1:1 matched groups and IPTW Cox models yielded similar results.

Tonsillectomy and immunosuppressive therapy may be effective for remission induction and delaying progression in high-risk IgAN patients.