0 mg/dl; (4) an estimated glomerular filtration rate (eGFR) of 30 ml/min/1.73 m2 or higher; (5) age <70 years; and (6) willingness to provide written informed consent. We excluded patients for whom steroids were contraindicated PI3K inhibitor and also those in whom the renal disease was associated with systemic lupus erythematosus or other systemic diseases. Patients whose urinary protein/creatinine ratio was less than 0.1 (g/g) were also excluded from the study. Therapeutic intervention After obtaining informed consent,

bilateral palatine tonsillectomy was performed on all patients. One week after surgery, intravenous methylprednisolone (mPSL) pulse therapy (500 mg/day) was administered for 3 days, and each patient was started on an antiplatelet drug (dilazep hydrochloride or dipyridamole), an anti-ulcer

learn more drug, and sulfamethoxazole-trimethoprim (SMX–TMP). After the mPSL pulse therapy, the patients continued to receive oral prednisolone (PSL) at a dose of 30 mg per day for 4 weeks, and then once every 2 days thereafter in combination with MZR at 150 mg/day once daily. The dose of PSL was then decreased by 5 mg every 4 weeks and discontinued in the 7th month. SMX-TMP and the anti-ulcer drug were discontinued, in principle, when the PSL dose was 20 mg administered every 2 days. MZR and the antiplatelet drug were continued for 11 months (Fig. 1). Patients with hypertension received an antihypertensive drug such as a renin-angiotensin

system inhibitor. Fig. 1 Tonsillectomy plus steroid pulse + oral steroid + mizoribine therapy protocol: time-course change in rates of CR of IgAN (rates of remission of proteinuria and hematuria). Therapy was started (0) at the time of tonsillectomy (inverted triangle); 1 week later, one course of methylprednisolone pulse therapy (downward arrow) was administered. Sulfamethoxazole-trimethoprim PD184352 (CI-1040) (SMX-TMP), an antiplatelet drug, and an anti-ulcer drug were administered. An oral steroid was then administered at a dose of 30 mg daily for 4 weeks, and then once every 2 days in combination with MZR at a dose of 150 mg once daily. MZR was administered for 11 months, and the antiplatelet drug was administered for 12 months. SMX-TMP and the anti-ulcer drug were administered for 13 weeks and then discontinued. The dose of the steroid was gradually reduced until the end of 7 months, and then discontinued. The rates of CR of IgAN were determined as the rates of remission of proteinuria and hematuria at 6, 12, and 24 months. The number of patients was 42.