Kobayashi et al. reported effectiveness of steroids for IgA nephropathy in 1988 [8]. At that time, oral steroids were the mainstay of treatment, and less than 1.0 g/day was commonly accepted as target proteinuria. With advances in treatment, target proteinuria may undergo a paradigm shift. In 2001, Hotta et al. proposed the concept of clinical remission defined by complete disappearance of proteinuria and hematuria at final observation as opposed to partial remission, as the treatment goal [9]. They reported an observational study composed by 329 cases of IgA nephropathy with a mean observation period of 6.9 years (Table 17.1). In this cohort, 197 cases received steroid pulse therapy, 250 cases had tonsillectomy, and 95 cases had immunosuppressive therapy. At the end of the observation period, among 158 cases with clinical remission, no one had 1.5 times increase in serum creatinine concentration from baseline, making it a more favorable outcome compared to the 24 cases (14 %) among 172 cases with no clinical remission. Furthermore, by multivariate analysis, steroid pulse therapy and tonsillectomy were shown to have significantly contributed to the achievement of clinical remission. Taken altogether, they recommend combination of steroid pulse therapy and tonsillectomy, and hence their suggestion of clinical remission as the goal in management of IgA nephropathy.