扁桃体切除术治疗免疫球蛋白A血管炎合并肾炎:病例系列。

IF 1 Q4 UROLOGY & NEPHROLOGY
Eisuke Kubo, Kotaro Haruhara, Hirokazu Marumoto, Takaya Sasaki, Masahiro Okabe, Shinya Yokote, Akihiro Shimizu, Hiroyuki Ueda, Nobuo Tsuboi, Takashi Yokoo
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引用次数: 0

摘要

成人发病的免疫球蛋白A血管炎伴肾炎(IgAV肾炎)的治疗尚无共识。扁桃体切除术是原发性IgA肾病的一种治疗选择,其组织病理学特征和发病机制与IgAV肾炎相似。本病例系列旨在描述IgAV肾炎患者的临床过程谁接受扁桃体切除术在我们的机构。对日本6家医院2015年至2022年接受扁桃体切除术的活检证实的IgAV肾炎成年患者进行了系统回顾。在扁桃体切除术前后评估血尿、蛋白尿和估计肾小球滤过率(eGFR)斜率。在研究期间进行的2626例肾活检中,有12例发现IgAV肾炎患者接受了扁桃体切除术。扁桃体切除术前后的中位观察时间分别为20.7个月和48.6个月。扁桃体切除术同时给予以下药物:皮质类固醇(n = 8),米佐利滨(n = 1)和利妥昔单抗(n = 1)。3例患者未接受皮质类固醇或免疫抑制剂治疗。扁桃体切除术后观察,5例患者血尿缓解。在扁桃体切除术前蛋白尿未缓解的10例患者中,7例扁桃体切除术后蛋白尿缓解。9例患者扁桃体切除后eGFR斜率较扁桃体切除前有所降低。本研究提示,一些患者可能受益于扁桃体切除术治疗IgAV肾炎。扁桃体切除术或免疫抑制联合治疗IgAV肾炎的疗效需要进一步的病例系列来阐明扁桃体切除术相关患者的临床病理情况。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Tonsillectomy in Immunoglobulin A vasculitis with nephritis: case series.

There is no consensus-based treatment for adult-onset immunoglobulin A vasculitis with nephritis (IgAV nephritis). Tonsillectomy is a treatment option for primary IgA nephropathy, which has similar histopathological features and pathogenesis to IgAV nephritis. The present case series aimed to describe the clinical course of patients with IgAV nephritis who underwent tonsillectomy in our institution. Adult patients with biopsy-proven IgAV nephritis who received tonsillectomy from 2015 to 2022 were systematically reviewed at six hospitals in Japan. Hematuria, proteinuria and slope of the estimated glomerular filtration rate (eGFR) were evaluated before and after tonsillectomy. Patients with IgAV nephritis who underwent tonsillectomy was identified in 12 of 2626 kidney biopsies performed during the study period. The median observation periods before and after tonsillectomy were 20.7 and 48.6 months, respectively. The following drugs were administered concurrent with tonsillectomy: corticosteroids (n = 8), mizoribin (n = 1), and rituximab (n = 1). Three patients were not treated with corticosteroids or immunosuppressants. During post-tonsillectomy observation, 5 patients showed remission of hematuria. Of the 10 patients whose proteinuria was not at a remission level prior to tonsillectomy, 7 showed remission of proteinuria after tonsillectomy. The eGFR slope was attenuated in 9 patients after tonsillectomy relative to before tonsillectomy. This study suggests that some patients may benefit from tonsillectomy in the treatment of IgAV nephritis. The efficacy of tonsillectomy or combination therapy with immunosuppression for IgAV nephritis requires further case series to clarify the clinicopathologic picture of patients associated with a response to tonsillectomy.

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来源期刊
CEN Case Reports
CEN Case Reports UROLOGY & NEPHROLOGY-
CiteScore
1.90
自引率
0.00%
发文量
80
期刊介绍: Clinical and Experimental Nephrology (CEN) Case Reports is a peer-reviewed online-only journal, officially published biannually by the Japanese Society of Nephrology (JSN).  The journal publishes original case reports in nephrology and related areas.  The purpose of CEN Case Reports is to provide clinicians and researchers with a forum in which to disseminate their personal experience to a wide readership and to review interesting cases encountered by colleagues all over the world, from whom contributions are welcomed.
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