01). The low and high dialysis induction risk patients showed no difference to the moderate risk patients. As for the therapeutics, the HR of the T and TSP groups were 0.314 (0.11–0.93) and 0.032 (0.00–0.28), respectively, compared to the N group (P < 0.05, < 0.01). The HR for doubling serum creatinine levels of the TOS group showed no difference with the N group [HR 0.213 (0.04–1.10), P = 0.065]. Table 7 (a) Multivariate-adjusted and (b) univariate hazard ratios for development of 100 % increase of serum creatinine   B Standard error Wald P value HR 95 % CI (a) Male (vs. female) 1.013 0.459 4.876 0.027 2.76 1.22–6.77  Age (vs. ≤40 years) 1.075 0.419 6.577 0.010 2.93 1.29–6.66 Histological activity (chronic)

        1 (reference)    Acute −10.023 429.684 0.001 0.981 <0.001 0.00– <1000  Acute + chronic 0.926 0.456 4.123 0.042 2.53 1.03–6.17 Dialysis induction risk (moderate)         1 (reference)    Low click here risk −11.481 205.756 0.003 0.956 <0.001 –  High risk 1.003 0.587 2.916 0.088 2.73 0.86–8.61  Very high risk 2.526 0.540 21.860 0.000 12.50 4.34–36.0 Method of therapy (N)         1 (reference) GDC-0941 ic50    T group −1.159 0.554 4.372 0.037 0.314 0.11–0.93  TOS group −1.545 0.837 3.410 0.065 0.213 0.04–1.10  TSP group −3.449 1.114 9.588 0.002 0.032 0.00–0.28  Use of ACEI or ARB (vs use) 0.956 0.522 3.355 0.067 2.60 0.94–7.24 (b)  eGFR  > 60 ml/min/1.73 m2         1 (reference)

    <60 ml/min/1.73 m2 1.992 0.405 24.206 <0.000 7.33 3.31–16.2  Urinary protein < 0.5 g/day         1 (reference)     >0.5 g/day 2.227 1.029 4.686 0.030 9.29 1.23–69.7 Histological grade (I) selleck screening library         1 (reference)     II 1.424 0.588 5.870 0.015 4.16 1.31–13.2   III 2.031 0.561 13.127 <0.000 7.62 2.54–22.9   IV 2.916 0.563 26.851 <0.000 18.47 6.13–66.7 PSL prednisolone, TSP group tonsillectomy + steroid pulse, N no particular therapy, T tonsillectomy alone, TOS group tonsillectomy + oral PSL, ACEI angiotensin-converting enzyme inhibitor,

ARB angiotensin-II receptor blocker, eGFR estimated glomerular filtration rate (ml/min/1.73 m2) Adverse effect Three patients developed steroid-induced psychosis (one in TOS group, two in TSP group). Three patients developed diabetes mellitus and required insulin (one in TOS group, two in TSP group) and received treatment. One patient in the N group died of pneumonia before the endpoint. No patient had any serious side-effect such as aseptic necrosis of femoral bone. Discussion The purpose of this study was to clarify effects of each treatment method on long-term renal survival in adult IgAN patients. To our knowledge, there is no report available from a single institution that compares long-term renal survival among the above treatment methods in adult patients with IgAN. In our institution, tonsillectomy has been performed for patients with IgAN for 25 years. In our institute, TSP therapy was started in 2003. Before 2002, there were no definite criteria of the selection of the treatments (T, TOS, and N).