Tonsillectomy with steroid pulse: a curative therapy for IgA nephropathy.

IgA nephropathy (IgAN), the most common form of primary glomerulonephritis progressing to end-stage renal disease (ESRD), has been regarded as an incurable disease. However, in recent years, it has been demonstrated that combined tonsillectomy with steroid pulse (TS) therapy, if administrated in the relatively early stage of the disease, can yield clinical remission in patients with IgAN. However, clinical remission is no longer obtained when the same treatment is administrated in cases with more advanced disease and/or a longer duration of nephropathy. Thus, the paradigm of managing IgAN patients is shifting in Japan from 'slowing the progression and the delaying the onset of ESRD' (by conventional therapy using a RAS inhibitor and/or corticosteroids at low doses in selected patients with advanced IgAN) to 'achieving remission' by the TS therapy in patients with early disease. In the new paradigm aimed at clinical remission, the principle for initiation of TS therapy should be 'the earlier, the better'.