A meta-analysis of the clinical remission rate and long-term efficacy of tonsillectomy in patients with IgA nephropathy

Background. We wished to evaluate the clinical remission rate and long-term efficacy of tonsillectomy for patients with IgA nephropathy. Methods. We searched a number of databases, including PubMed, CNKI, Wanfang and others, for clinical case-control studies of tonsillectomy in patients with IgA nephropathy. We then performed a meta-analysis of these studies. After evaluating total clinical remission rates, we compared the remission rates for specific treatments: tonsillectomy plus steroid pulse, tonsillectomy plus normal-dose steroid, and general treatment using neither tonsillectomy nor steroids. We also compared the rates of end-stage renal failure (ESRF) at last follow-up to estimate the long-term renal survival rate associated with each treatment. Results. Seven retrospective studies met the inclusion criteria and were included. These included a total of 858 patients, in which 534 underwent tonsillectomy and 324 did not. The total clinical remission rate was higher in the operative group, while the ESRF rate was higher in the non-operative group. The clinical remission rate in patients who underwent tonsillectomy remained higher than in the non-operative group at both 5- and 10-year follow-up. The clinical remission rate in patients who underwent tonsillectomy plus steroid pulse was higher than in those treated with steroid pulse alone, normal-dose steroids or general treatment alone (P < 0.05). However, the clinical remission rate of simple tonsillectomy was not higher than that of general treatment (P > 0.05). Conclusions. Whereas neither tonsillectomy nor steroid treatment alone increased remission rates in patients with IgA nephropathy, tonsillectomy combined with either normal steroid or steroid pulse treatment resulted in higher remission rates with favourable long-term efficacy.