Immunosuppression, tonsillectomy and remissions in high-risk IgA-nephropathy

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Abstract

Aim.To evaluate the efficacy of immunosuppressive therapy (IST) and tonsillectomy (TE) in patients with high-risk IgA nephropathy (IgAN).

Materials and мethods. The retrospective study cohort included cases with primary IgAN (n=213, age 34±11 years, male 52%) at high risk of progression with clinical and morphological data collected. The follow-up was 26 (10; 61) months. The association of IST without TE (IST; n=141) or with TE (IST+TE; n=72) with the development of complete (PR), partial (PR) and overall (PR or PR, OR) remissions was investigated.

Results. The incidence of achieving early PR or OR in the IST and IST+TE groups was 65.2% and 86.1%, respectively (p=0.002). The probability of early PR or OR was significantly increased in the IST+TE group compared to IST [HR 1.714 (1.214–2.420) and HR 3.410 (1.309–8.880), respectively]. IST+TE was associated with a 3- to 4-fold increase in the likelihood of PR or OR at the end of follow-up [HR 2.575 (1.679–3.950) and HR 4.768 (2.434–9.337), respectively]. Analyses using pseudorandomisation methods yielded similar results.

Conclusion. TE may be effective for remission induction in high-risk IgAN.

About the authors

Zinaida Sh. Kochoyan

Pavlov First Saint Petersburg State Medical University

Email: dobronravov@nephrolog.ru
ORCID iD: 0000-0001-8433-876X

врач-нефролог нефрологического отд-ния №3 Научно-исследовательского института нефрологии

Russian Federation, Saint Petersburg

Alina Z. Lieva

Pavlov First Saint Petersburg State Medical University

Email: dobronravov@nephrolog.ru
ORCID iD: 0009-0006-3800-1246

клин. ординатор каф. пропедевтики внутренних болезней

Russian Federation, Saint Petersburg

Tatyana O. Galkovskaya

Pavlov First Saint Petersburg State Medical University

Email: dobronravov@nephrolog.ru
ORCID iD: 0009-0008-8851-8061

врач-нефролог нефрологического отд-ния №2 Научно-исследовательского института нефрологии

Russian Federation, Saint Petersburg

Vladimir A. Dobronravov

Pavlov First Saint Petersburg State Medical University

Author for correspondence.
Email: dobronravov@nephrolog.ru
ORCID iD: 0000-0002-7179-5520

д-р мед. наук, проф., дир. Научно-исследовательского института нефрологии

Russian Federation, Saint Petersburg

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2. Fig. 1. Cumulative rates of overall remissions in groups IST+TE and IST only, retrospectively: a – without pseudorandomization; b – with pseudorandomization. Vertical dotted lines – median time-to-remission, the shaded area – 95% confidence interval.

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