A modern understanding of IgA nephropathy and hemorrhagic vasculitis as tonsillogenic diseases and effects of tonsillectomy on their progression

Abstract

IgA nephropathy and hemorrhagic vasculitis are IgA-mediated meta-tonsillar diseases. The literature on their pathogenesis, association with chronic tonsillitis, and effects of tonsillectomy on their progression was reviewed. In patients with IgA nephropathy, tonsillectomy is associated with higher rates of clinical remission, suppressing progression of renal failure as a result of decreased mucosal production of abnormally galactosylated IgA1 molecules. This finding is supported by high-quality studies in Asian populations and isolated comparative studies in Caucasians. For this reason, Asian guidelines, especially Japanese, include tonsillectomy as a treatment option for this group of patients. In hemorrhagic vasculitis, tonsillectomy is only effective in clinical forms with renal impairment. For other forms, symptomatic treatment is preferred, and tonsillectomy is indicated when there is a proven association between attacks of chronic tonsillitis and deterioration of kidney function. Further research is needed in this area with a larger population of patients with IgA-mediated diseases and with the ability to evaluate the impact of genetic characteristics on treatment outcome.