{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T18:53:13Z","timestamp":1785351193599,"version":"3.55.0"},"reference-count":52,"publisher":"Oxford University Press (OUP)","issue":"7","license":[{"start":{"date-parts":[[2025,12,16]],"date-time":"2025-12-16T00:00:00Z","timestamp":1765843200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"name":"Russian Foundation for Scientific Research","award":["23-15-00510"],"award-info":[{"award-number":["23-15-00510"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,6,30]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Considering the absence of such data, this study explored the effectiveness of immunosuppressive therapy (IST) and tonsillectomy (TE) in Caucasians with high-risk immunoglobulin A nephropathy (IgAN).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>The prospective non-randomised comparative study enrolled incident Caucasian patients with a definite clinical and histological diagnosis of primary IgAN (n\u00a0=\u00a0221, age 35\u00a0\u00b1\u00a011\u00a0years, 52% male) at high risk of progression. All patients received IST (72.3% glucocorticoid monotherapy) without TE (control group, n\u00a0=\u00a0136) or with TE (TE\u00a0+\u00a0IST; experimental group, n\u00a0=\u00a085). The median follow-up period was 33\u00a0months (interquartile range 15\u201369). Kaplan\u2013Meier and Cox regression analyses combined with pseudo-randomisation methods (1:1 matching of comparison groups) and inverse probability of treatment weighting (IPTW) were applied to assess the effects of TE\u00a0+\u00a0IST on primary outcomes: complete remission (CR), overall (complete or partial) remission (OR) and disease progression (&amp;gt;40% decrease in estimated glomerular filtration rate or end-stage kidney disease).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The rates of early OR in the IST and TE\u00a0+\u00a0IST groups were 72.6% and 95.2%, respectively (P\u00a0&amp;lt;\u00a0.001). In the Kaplan\u2013Meier analyses, the time to remission was 2-fold shorter in the TE\u00a0+\u00a0IST group (P\u00a0&amp;lt;\u00a0.001). In the adjusted Cox models, the probabilities of early OR and CR were significantly higher in the tonsillectomy group compared with IST alone {hazard ratio [HR] 3.364 [95% confidence interval (CI) 2.302\u20134.917] and HR 6.315 [95% CI 2.620\u201315.224], respectively}. The disease progression was registered in 3 patients (3.5%) in those on the combination therapy compared with 39 patients (28.9%) in the IST group [adjusted HR 0.126 (95% CI 0.037\u20130.427)]. Analyses performed in propensity score 1:1 matched groups and IPTW Cox models yielded similar results.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Tonsillectomy and immunosuppressive therapy may be effective for remission induction and delaying progression in high-risk IgAN patients.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ndt\/gfaf262","type":"journal-article","created":{"date-parts":[[2025,12,15]],"date-time":"2025-12-15T12:34:36Z","timestamp":1765802076000},"page":"1284-1293","source":"Crossref","is-referenced-by-count":1,"title":["Tonsillectomy and immunosuppression improve outcomes in Caucasians with high-risk IgA nephropathy"],"prefix":"10.1093","volume":"41","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8433-876X","authenticated-orcid":false,"given":"Zinaida S","family":"Kochoyan","sequence":"first","affiliation":[{"name":"Research Institute of Nephrology, Pavlov University Department of Nephrology, , Saint Petersburg ,","place":["Russian Federation"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7179-5520","authenticated-orcid":false,"given":"Vladimir A","family":"Dobronravov","sequence":"additional","affiliation":[{"name":"Research Institute of Nephrology, Pavlov University Department of Nephrology, , Saint Petersburg ,","place":["Russian Federation"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2025,12,16]]},"reference":[{"key":"2026062922474159600_bib1","doi-asserted-by":"publisher","first-page":"435","DOI":"10.1016\/j.semnephrol.2018.05.013","article-title":"Epidemiology of IgA nephropathy: a global perspective","volume":"38","author":"Schena","year":"2018","journal-title":"Semin Nephrol"},{"key":"2026062922474159600_bib2","doi-asserted-by":"publisher","first-page":"727","DOI":"10.2215\/CJN.0000000000000135","article-title":"Long-term outcomes in IgA nephropathy","volume":"18","author":"Pitcher","year":"2023","journal-title":"Clin J Am Soc Nephrol"},{"key":"2026062922474159600_bib3","doi-asserted-by":"publisher","first-page":"CD003962","DOI":"10.1002\/14651858.CD003962.pub3","article-title":"Non-immunosuppressive treatment for IgA nephropathy","volume":"2024","author":"Tunnicliffe","year":"2024","journal-title":"Cochrane Database Syst Rev"},{"key":"2026062922474159600_bib4","doi-asserted-by":"publisher","first-page":"640","DOI":"10.1016\/j.kint.2025.01.014","article-title":"Treatment of patients with IgA nephropathy: a call for a new paradigm","volume":"107","author":"Floege","year":"2025","journal-title":"Kidney Int"},{"key":"2026062922474159600_bib5","doi-asserted-by":"publisher","first-page":"203","DOI":"10.1016\/j.ekir.2023.11.026","article-title":"Novel treatments for IgA nephropathy","volume":"9","author":"Selvaskandan","year":"2024","journal-title":"Kidney Int Rep"},{"issue":"4 Suppl","key":"2026062922474159600_bib6","doi-asserted-by":"publisher","first-page":"S1","DOI":"10.1016\/j.kint.2021.05.021","article-title":"KDIGO 2021 clinical practice guideline for the management of glomerular diseases","volume":"100","author":"Kidney Disease: Improving Global Outcomes Glomerular Diseases Work Group","year":"2021","journal-title":"Kidney Int"},{"key":"2026062922474159600_bib7","doi-asserted-by":"publisher","first-page":"333","DOI":"10.1186\/s12882-019-1519-3","article-title":"Efficacy and safety of immunosuppressive treatment in IgA nephropathy: a meta-analysis of randomised controlled trials","volume":"20","author":"Zhang","year":"2019","journal-title":"BMC Nephrol"},{"key":"2026062922474159600_bib8","doi-asserted-by":"publisher","first-page":"1890","DOI":"10.1159\/000496000","article-title":"Efficacy and safety of agents in IgA nephropathy: an update network meta-analysis","volume":"43","author":"Yang","year":"2018","journal-title":"Kidney Blood Press Res"},{"key":"2026062922474159600_bib9","doi-asserted-by":"publisher","first-page":"CD003965","DOI":"10.1002\/14651858.CD003965.pub3","article-title":"Immunosuppressive agents for treating IgA nephropathy","volume":"3","author":"Natale","year":"2020","journal-title":"Cochrane Database Syst Rev"},{"key":"2026062922474159600_bib10","doi-asserted-by":"publisher","first-page":"1515723","DOI":"10.3389\/fmed.2025.1515723","article-title":"Efficacy and safety of agents for IgA nephropathy: a network meta-analysis of randomized controlled trials","volume":"12","author":"Chen","year":"2025","journal-title":"Front Med"},{"key":"2026062922474159600_bib11","doi-asserted-by":"publisher","first-page":"432","DOI":"10.1001\/jama.2017.9362","article-title":"Effect of oral methylprednisolone on clinical outcomes in patients with IgA nephropathy the TESTING randomized clinical trial","volume":"318","author":"Lv","year":"2017","journal-title":"JAMA"},{"key":"2026062922474159600_bib12","doi-asserted-by":"publisher","first-page":"317","DOI":"10.1681\/ASN.2017060713","article-title":"Effects of two immunosuppressive treatment protocols for IgA nephropathy","volume":"29","author":"Rauen","year":"2018","journal-title":"J Am Soc Nephrol"},{"key":"2026062922474159600_bib13","doi-asserted-by":"publisher","first-page":"788","DOI":"10.1053\/j.ajkd.2016.11.027","article-title":"Mycophenolate mofetil combined with prednisone versus full-dose prednisone in IgA nephropathy with active proliferative lesions: a randomized controlled trial","volume":"69","author":"Hou","year":"2017","journal-title":"Am J Kidney Dis"},{"key":"2026062922474159600_bib14","doi-asserted-by":"publisher","first-page":"255","DOI":"10.1038\/s41598-021-03691-0","article-title":"Effect of pulsed intravenous methylprednisolone with alternative low-dose prednisone on high-risk IgA nephropathy: a 18-month prospective clinical trial","volume":"12","author":"Li","year":"2022","journal-title":"Sci Rep"},{"key":"2026062922474159600_bib15","doi-asserted-by":"publisher","first-page":"3694","DOI":"10.1093\/ndt\/gfp356","article-title":"Randomized controlled clinical trial of corticosteroids plus ACE-inhibitors with long-term follow-up in proteinuric IgA nephropathy","volume":"24","author":"Manno","year":"2009","journal-title":"Nephrol Dial Transplant"},{"key":"2026062922474159600_bib16","doi-asserted-by":"publisher","first-page":"86","DOI":"10.1002\/iid3.248","article-title":"Recent advances in the immunological understanding of association between tonsil and immunoglobulin a nephropathy as a tonsil-induced autoimmune\/inflammatory syndrome","volume":"7","author":"Harabuchi","year":"2019","journal-title":"Immun Inflam Dis"},{"key":"2026062922474159600_bib17","doi-asserted-by":"publisher","first-page":"103","DOI":"10.1007\/s11255-016-1432-7","article-title":"Long-term efficacy of tonsillectomy as a treatment in patients with IgA nephropathy: a meta-analysis","volume":"49","author":"Duan","year":"2017","journal-title":"Int Urol Nephrol"},{"key":"2026062922474159600_bib18","doi-asserted-by":"publisher","first-page":"1923","DOI":"10.1093\/ndt\/gfq674","article-title":"A meta-analysis of the clinical remission rate and long-term efficacy of tonsillectomy in patients with IgA nephropathy","volume":"26","author":"Wang","year":"2011","journal-title":"Nephrol Dial Transplant"},{"key":"2026062922474159600_bib19","doi-asserted-by":"publisher","first-page":"80","DOI":"10.1053\/j.ajkd.2014.06.036","article-title":"Tonsillectomy for IgA nephropathy: a meta-analysis","volume":"65","author":"Liu","year":"2015","journal-title":"Am J Kidney Dis"},{"key":"2026062922474159600_bib20","doi-asserted-by":"publisher","first-page":"2175","DOI":"10.1007\/s11255-014-0818-7","article-title":"Effect of tonsillectomy and its timing on renal outcomes in Caucasian IgA nephropathy patients","volume":"46","author":"Kov\u00e1cs","year":"2014","journal-title":"Int Urol Nephrol"},{"key":"2026062922474159600_bib21","doi-asserted-by":"publisher","first-page":"15","DOI":"10.1159\/000441852","article-title":"Tonsillectomy in a European cohort of 1,147 patients with IgA nephropathy","volume":"132","author":"Feehally","year":"2016","journal-title":"Nephron"},{"key":"2026062922474159600_bib22","first-page":"147","article-title":"Tonsillectomy does not prevent a progressive course in IgA nephropathy","volume":"51","author":"Rasche","year":"1999","journal-title":"Clin Nephrol"},{"key":"2026062922474159600_bib23","doi-asserted-by":"publisher","first-page":"2583","DOI":"10.1093\/ndt\/gfq107","article-title":"Influence of tonsillectomy on the progression of mesangioproliferative glomerulonephritis","volume":"25","author":"Piccoli","year":"2010","journal-title":"Nephrol Dial Transplant"},{"key":"2026062922474159600_bib24","doi-asserted-by":"publisher","first-page":"942","DOI":"10.1001\/jamainternmed.2019.0600","article-title":"Evaluating a new international risk-prediction tool in IgA nephropathy","volume":"179","author":"Barbour","year":"2019","journal-title":"JAMA Intern Med"},{"key":"2026062922474159600_bib25","doi-asserted-by":"publisher","first-page":"1014","DOI":"10.1016\/j.kint.2017.02.003","article-title":"Oxford classification of IgA nephropathy 2016: an update from the IgA nephropathy classification working group","volume":"91","author":"Trimarchi","year":"2017","journal-title":"Kidney Int"},{"key":"2026062922474159600_bib26","doi-asserted-by":"publisher","first-page":"2837","DOI":"10.1002\/sim.5705","article-title":"The performance of different propensity score methods for estimating marginal hazard ratios","volume":"32","author":"Austin","year":"2013","journal-title":"Stat Med"},{"key":"2026062922474159600_bib27","doi-asserted-by":"publisher","first-page":"268","DOI":"10.7326\/M16-2607","article-title":"Sensitivity analysis in observational research: introducing the E-value","volume":"167","author":"VanderWeele","year":"2017","journal-title":"Ann Intern Med"},{"key":"2026062922474159600_bib28","volume-title":"R: a language and environment for statistical computing","author":"R Core Team","year":"2022"},{"key":"2026062922474159600_bib29","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1016\/j.mce.2007.05.019","article-title":"Molecular mechanisms of glucocorticoid action and selective glucocorticoid receptor agonists","volume":"275","author":"Stahn","year":"2007","journal-title":"Mol Cell Endocrinol"},{"key":"2026062922474159600_bib30","doi-asserted-by":"publisher","first-page":"1652","DOI":"10.2215\/CJN.01300121","article-title":"Poly-IgA complexes and disease severity in IgA nephropathy","volume":"16","author":"Zhang","year":"2021","journal-title":"Clin J Am Soc Nephrol"},{"key":"2026062922474159600_bib31","doi-asserted-by":"publisher","first-page":"1888","DOI":"10.1001\/jama.2022.5368","article-title":"Effect of oral methylprednisolone on decline in kidney function or kidney failure in patients with IgA nephropathy: the TESTING randomized clinical trial","volume":"327","author":"Lv","year":"2022","journal-title":"JAMA"},{"key":"2026062922474159600_bib32","doi-asserted-by":"publisher","first-page":"2068","DOI":"10.3389\/fimmu.2020.02068","article-title":"Association between galactose-deficient IgA1 derived from the tonsils and recurrence of IgA nephropathy in patients who underwent kidney transplantation.","volume":"11","author":"Kawabe","year":"2020","journal-title":"Front Immunol"},{"key":"2026062922474159600_bib33","doi-asserted-by":"publisher","first-page":"6785","DOI":"10.3390\/jcm11226785","article-title":"Time-averaged hematuria as a prognostic indicator of renal outcome in patients with IgA nephropathy","volume":"11","author":"Weng","year":"2022","journal-title":"J Clin Med"},{"key":"2026062922474159600_bib34","doi-asserted-by":"publisher","first-page":"3089","DOI":"10.1681\/ASN.2017010108","article-title":"Remission of hematuria improves renal survival in IgA nephropathy","volume":"28","author":"Sevillano","year":"2017","journal-title":"J Am Soc Nephrol"},{"key":"2026062922474159600_bib35","doi-asserted-by":"publisher","first-page":"1195","DOI":"10.1093\/ndt\/gfac025","article-title":"Indication for corticosteroids in IgA nephropathy: validation in the European VALIGA cohort of a treatment score based on the Oxford classification","volume":"37","author":"Cambier","year":"2022","journal-title":"Nephrol Dial Transplant"},{"key":"2026062922474159600_bib36","doi-asserted-by":"publisher","first-page":"99","DOI":"10.1016\/j.ekir.2021.10.007","article-title":"A novel scoring system based on oxford classification indicating steroid therapy use for IgA nephropathy","volume":"7","author":"Itami","year":"2022","journal-title":"Kidney Int Rep"},{"key":"2026062922474159600_bib37","doi-asserted-by":"publisher","first-page":"3177","DOI":"10.1681\/ASN.2007050526","article-title":"Remission of proteinuria improves prognosis in IgA nephropathy","volume":"18","author":"Reich","year":"2007","journal-title":"J Am Soc Nephrol"},{"key":"2026062922474159600_bib38","doi-asserted-by":"publisher","first-page":"157","DOI":"10.1097\/01.ASN.0000103869.08096.4F","article-title":"Corticosteroid effective- ness in IgA nephropathy: long-term results of a randomized, controlled trial","volume":"15","author":"Pozzi","year":"2004","journal-title":"J Am Soc Nephrol"},{"key":"2026062922474159600_bib39","doi-asserted-by":"publisher","first-page":"13663","DOI":"10.1038\/s41598-018-31727-5","article-title":"A comparison of the effectiveness of cyclophosphamide, leflunomide, corticosteroids, or conservative management alone in patients with IgA nephropathy: a retrospective observational study","volume":"8","author":"Chen","year":"2018","journal-title":"Sci Rep"},{"key":"2026062922474159600_bib40","doi-asserted-by":"publisher","first-page":"469","DOI":"10.1007\/s11255-012-0251-8","article-title":"Comparison between steroid pulse therapy alone and in combination with tonsillectomy for IgA nephropathy","volume":"45","author":"Ochi","year":"2013","journal-title":"Int Urol Nephrol"},{"key":"2026062922474159600_bib41","doi-asserted-by":"publisher","first-page":"242","DOI":"10.3109\/0886022X.2015.1128251","article-title":"The efficacy of tonsillectomy on clinical remission and relapse in patients with IgA nephropathy: a randomized controlled trial","volume":"38","author":"Yang","year":"2016","journal-title":"Ren Fail"},{"key":"2026062922474159600_bib42","doi-asserted-by":"publisher","first-page":"340","DOI":"10.1053\/j.ajkd.2021.03.007","article-title":"Association of treatment effects on early change in urine protein and treatment effects on GFR slope in IgA nephropathy: an individual participant meta-analysis","volume":"78","author":"Inker","year":"2021","journal-title":"Am J Kidney Dis"},{"key":"2026062922474159600_bib43","doi-asserted-by":"publisher","first-page":"425","DOI":"10.1007\/s10157-015-1170-7","article-title":"Tonsillectomy reduces recurrence of IgA nephropathy in mesangial hypercellularity type categorized by the Oxford classification","volume":"20","author":"Hirano","year":"2016","journal-title":"Clin Exp Nephrol"},{"key":"2026062922474159600_bib44","doi-asserted-by":"publisher","first-page":"47","DOI":"10.5414\/CN107861","article-title":"Tonsillectomy with steroid pulse therapy has more effect on the relapse rate than steroid pulse monotherapy in IgA nephropathy patients","volume":"80","author":"Ohya","year":"2013","journal-title":"Clin Nephrol"},{"key":"2026062922474159600_bib45","doi-asserted-by":"publisher","first-page":"555","DOI":"10.1007\/s10157-012-0744-x","article-title":"The predictive value of attenuated proteinuria at 1 year after steroid therapy for renal survival in patients with IgA nephropathy","volume":"17","author":"Hirano","year":"2013","journal-title":"Clin Exp Nephrol"},{"key":"2026062922474159600_bib46","doi-asserted-by":"publisher","first-page":"436","DOI":"10.1681\/ASN.2020030349","article-title":"Quantifying duration of proteinuria remission and association with clinical outcome in IgA nephropathy","volume":"32","author":"Canney","year":"2021","journal-title":"J Am Soc Nephrol"},{"key":"2026062922474159600_bib47","doi-asserted-by":"publisher","first-page":"1270","DOI":"10.34067\/KID.0003932020","article-title":"Long-term beneficial effects of tonsillectomy on patients with immunoglobulin a nephropathy","volume":"1","author":"Moriyama","year":"2020","journal-title":"Kidney360"},{"key":"2026062922474159600_bib48","doi-asserted-by":"publisher","first-page":"e194772","DOI":"10.1001\/jamanetworkopen.2019.4772","article-title":"Association between tonsillectomy and outcomes in patients with immunoglobulin a nephropathy","volume":"2","author":"Hirano","year":"2019","journal-title":"JAMA Netw Open"},{"key":"2026062922474159600_bib49","doi-asserted-by":"publisher","first-page":"1108","DOI":"10.1093\/ndt\/gfg108","article-title":"Tonsillar IgA1 as a possible source of hypoglycosylated IgA1 in the serum of IgA nephropathy patients","volume":"18","author":"Itoh","year":"2003","journal-title":"Nephrol Dial Transplant"},{"key":"2026062922474159600_bib50","doi-asserted-by":"publisher","first-page":"708","DOI":"10.1016\/j.humimm.2012.10.028","article-title":"The role of memory B cell in tonsil and peripheral blood in the clinical progression of IgA nephropathy","volume":"74","author":"Wu","year":"2013","journal-title":"Hum Immunol"},{"key":"2026062922474159600_bib51","doi-asserted-by":"publisher","first-page":"770","DOI":"10.1007\/s10157-013-0921-6","article-title":"Serum levels of galactose-deficient immunoglobulin (Ig) A1 and related immune complex are associated with disease activity of IgA nephropathy","volume":"18","author":"Suzuki","year":"2014","journal-title":"Clin Exp Nephrol"},{"key":"2026062922474159600_bib52","doi-asserted-by":"publisher","first-page":"493","DOI":"10.1053\/ajkd.2002.31399","article-title":"Regression of IgA nephropathy: a repeat biopsy study","volume":"39","author":"Hotta","year":"2002","journal-title":"Am J Kidney Dis"}],"container-title":["Nephrology Dialysis Transplantation"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ndt\/advance-article-pdf\/doi\/10.1093\/ndt\/gfaf262\/65912674\/gfaf262.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ndt\/article-pdf\/41\/7\/1284\/65912674\/gfaf262.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ndt\/article-pdf\/41\/7\/1284\/65912674\/gfaf262.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T02:47:53Z","timestamp":1782787673000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ndt\/article\/41\/7\/1284\/8381236"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,16]]},"references-count":52,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2025,12,16]]},"published-print":{"date-parts":[[2026,6,30]]}},"URL":"https:\/\/doi.org\/10.1093\/ndt\/gfaf262","relation":{},"ISSN":["0931-0509","1460-2385"],"issn-type":[{"value":"0931-0509","type":"print"},{"value":"1460-2385","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,7]]},"published":{"date-parts":[[2025,12,16]]}}}