Editor’s Note: The following study results were first published in Nephrology Dialysis Transplantation (December 16, 2025) and later shared in the Oxford Academic. The original study authors are Zinaida S. Kochoyan, Vladimir A. Dobronravov. To see the results in their original DOI format, please click here.
Key Takeaways
A new prospective study suggests that combining tonsillectomy (TE) with immunosuppressive therapy (IST) significantly improves remission rates and slows disease progression in Caucasian patients with high-risk IgA nephropathy (IgAN).
Study Design
- Population: 221 incident Caucasian patients with biopsy-confirmed primary IgAN at high risk of progression
- Groups:
- IST only: 136 patients (72.3% on glucocorticoid monotherapy)
- TE + IST: 85 patients
- Follow-up: Median 33 months
- Analysis: Kaplan-Meier survival curves, Cox regression, and propensity score matching
Results
- Overall remission (OR):
- TE + IST: 94.1%
- IST only: 72.8% (p < 0.001)
- Time to remission:
- TE + IST achieved remission twice as fast (p < 0.001)
- Hazard ratios:
- OR: HR = 3.364 (95% CI: 2.302–4.917)
- Complete remission (CR): HR = 6.315 (95% CI: 2.620–15.224)
- Disease progression (>40% eGFR decline or ESKD):
- TE + IST: 3.5%
- IST only: 28.9%
- Adjusted HR = 0.126 (95% CI: 0.037–0.427)
Clinical Implications
The findings support tonsillectomy as an adjunct to immunosuppression for high-risk IgAN in Caucasian populations, offering better remission rates and reduced progression risk. While promising, the authors note that randomized controlled trials are needed to confirm these results.
