A case of immunoglobulin A nephropathy treated successfully with tonsillectomy and steroid pulse therapy 20 years after onset

A 46-year-old male was found to have proteinuria on a routine medical examination in 1985 at the age of 22 years and was diagnosed with immunoglobulin A (IgA) nephropathy by renal biopsy. He regularly visited a hospital, but 3 years later made the decision to stop. In 2000, his serum creatinine level was 1.3 mg/dl. His renal function then deteriorated, with persistent proteinuria and hematuria, following which he visited our hospital in December 2008. A further renal biopsy was performed. Active and chronic IgA nephropathy was confirmed histologically, with sclerosing lesions also being found. He was treated with three courses of steroid pulse therapy in February and tonsillectomy in April 2009. During the follow-up period at the outpatient clinic, results for proteinuria and hematuria were negative, suggesting that progression of renal impairment had been prevented. The efficacy of tonsillectomy plus steroid pulse therapy for early IgA nephropathy has been demonstrated, and this treatment was effective in our patient 20 years after the onset of the disease.