The efficacy of tonsillectomy on clinical remission and relapse in patients with IgA nephropathy: a randomized controlled trial

Figures & data

Table 1. Clinical characteristics of the initial cohort at renal biopsy classified by tonsillectomy.

Characteristic	Group A (n = 49)	Group B (n = 49)	p-Value
Age (years)	28.78 ± 7.08	31.28 ± 10.64	0.195
Weight (kg)	54.17 ± 9.09	57.94 ± 11.30	0.080
Systolic pressure (mmHg)	116.71 ± 12.17	120.21 ± 18.14	0.288
Diastolic pressure (mmHg)	77.10 ± 9.73	80.51 ± 13.53	0.175
Serum creatinine (μmol/L)	81.33 ± 19.45	92.82 ± 15.03	0.513
Uric acid (μmol/L)	331.57 ± 87.13	362.70 ± 125.90	0.167
eGFR (mL/min/1.73 m2)	95.00 ± 32.14	89.02 ± 37.29	0.278
Hematuria (10,000/mL)	9.96 ± 6.12	9.88 ± 6.24	0.258
Proteinuria (g/24h)	0.94 ± 1.03	1.36 ± 1.05	0.059
Patients receiving RASi	23 (47)	24 (49)	0.840
Gender
Male	22 (45)	23 (47)
Female	27 (55)	26 (53)	0.839
Histological grade
Good prognosis	1 (2)	1 (2)
Relatively good prognosis	4 (8)	5 (10)
Relatively poor prognosis	36 (73)	37 (76)
Poor prognosis	8 (16)	6 (12)	0.938

eGFR, estimated glomerular filtration rate; RASi, renin–angiotensin system inhibitors.

Data expressed as mean ± standard deviation or number of patients (%).

Table 2. Baseline histological characteristics.

Characteristic	Group A (n = 49)	Group B (n = 49)	p-Value
Number of glomeruli samples	14.33 ± 5.41	15.69 ± 7.58	NS
Glomerular sclerosis (%)	12.41 ± 10.02	14.52 ± 11.58	NS
No cellular crescents: n (%)	34 (69.4)	33 (67.3)	NS
Crescents: n (%)	15 (30.6)	16 (32.7)	NS
1–25% cellular crescents: n (%)	13 (26.5)	14 (28.6)	NS
25–50% cellular crescents: n (%)	2 (4.1)	2 (4.1)	NS
Oxford classification
M1: n (%)	44 (89.8)	42 (85.7)	NS
S1: n (%)	34 (69.4)	36 (73.4)	NS
E1: n (%)	14 (28.6)	15 (30.6)
T0: n (%)	34 (69.4)	35 (71.4)	NS
T1: n (%)	15 (30.6)	12 (24.5)	NS
T2: n (%)	0 (0)	2 (4.1)	NS
Present vascular change: n (%)	14 (28.6)	15 (30.6)	NS

M1, half the glomeruli have more than three cells in a mesangial area; S1, present segmental glomerulosclerosis or tuft adhesion; E1, present endocapillary hypercellularity; T, percentage of cortical area involved by the tubular atrophy or interstitial fibrosis, T0: 0–25%, T1: 26–50%, T2: >50%.

Table 3. Mean serum immunoglobulin A (IgA) and complement factor 3 (C3) levels and the IgA/C3 ratio in patients with IgA nephropathy at month 6.

	Group A		Group B
	Parameter	Month 0	Month 6	Month 0	Month 6
IgA (mmol/L)	2.95 ± 1.23	2.12 ± 0.84^a	3.00 ± 1.45	2.67 ± 1.08
C3 (mmol/L)	0.94 ± 0.33	1.14 ± 0.41^a	0.95 ± 0.47	0.99 ± 0.52
IgA/C3 ratio	3.71 ± 0.84	2.13 ± 0.39^a	3.74 ± 0.88	2.69 ± 0.50

^ap < 0.05 versus Group B at month 6.

Figure 1. Efficacy of tonsillectomy in urinalysis remission with IgAN patients: cumulative remission rate (91.8% vs. 46.9%, p < 0.001 by log-rank test) for hematuria (A) and (95.9% vs. 51.0%, p < 0.001) for proteinuria (B). The remission rate was calculated for hematuria and proteinuria using the Kaplan–Meier method.

Figure 2. Efficacy of tonsillectomy in urinalysis relapse with IgAN patients: the duration of first remission (26.5 vs. 11.8 months, p = 0.0047) for hematuria (A) and (23.5 vs. 10.5 months, p = 0.0012) for proteinuria (B), as well as lower relapse rate for hematuria and proteinuria in Group A. The relapse rate was calculated for hematuria and proteinuria using the Kaplan–Meier method.

Figure 3. Frequency of relapse during the trial period. The performance of tonsillectomy increased percentage of patients having fewer relapses of hematuria (A, B) and proteinuria (C, D). The difference in frequency was evaluated using Pearson’s chi-square test.