Effect of and Indication for Tonsillectomy in IgA Nephropathy

Abstract

Tamura S, Masuda Y, lnokuchi I, Terasawa K, Sugiyama N. Effect of and indication ,for tonsillectomq1 in IgA nephropurhy. Acta Otolaryngol (Stockh) 1993; Suppl 508: 23-28.Although more than 20 years have passed since the initial report of IgA nephropathy, the etiology of this disease is still unclear. Some reports suggest that the tonsil is an important etiological factor. We performed tonsillectomy on 26 patients with IgA nephropathy associated with chronic tonsillitis, and followed up the patients for two years after the operation to evaluate its clinical effect on this disease. Twelve patients (efficacy rate 46%) showed distinct improvement in urinary findings after the operation, although the efficacy rate went down as renal injury advanced. Serum IgA levels decreased significantly after the operation both in patients who improved and in those who did not; the decrease was especially evident in patients who had high levels of serum IgA before tonsillectomy. In 4 patients who improved. the level of circulating immune complex (CIC) was extremely high before, and decreased significantly after. the operation. One patient suffered renal failure three years after tonsillectomy. When renal injury has advanced to the clinically apparent degree, as occurred in this patient, tonsillectomy is absolutely contraindicated. In reaching a decision as to whether tonsillectomy is indicated in mild cases, the change in the number of erythrocytes in urinary sediments may be a sensitive parameter of the tonsillar provocation test. Key worcls: serum IgA, circulating immune comp1e.u. tonsillar protioration test. 583-90, 1984.

Long-Term Efficacy of Tonsillectomy in Chinese Patients with IgA Nephropathy

“…But multivariate analysis demonstrated that tonsillectomy was not an independent impact factor for renal clinical remission. Previous studies within the follow-up period of 6 months to 2 years demonstrated that tonsillectomy was useful for improvement in urinary findings in IgAN patients [4,6,7,8,9]. When the follow-up period was longer than 60 months, combination of tonsillectomy and immunosuppressant pulse therapy also had a favorable effect on clinical remission in IgAN patients [10, 11].…”

Evidence-based assessment of treatment options for children with IgA nephropathies

“…LOE for efficacy of therapy should be considered 6-S and 5-S, respectively. The study by Tamura et al [53] included seven pediatric patients among 26 treated with tonsillectomy. The outcome was good for four of these patients, while the other three showed no change.…”

Tonsillectomy and Steroid Pulse Therapy for IgA Nephropathy

“…Bene et al (1993) reported that the urinary protein level and microhematuria of 34 IgAN patients decreased significantly 6 months after tonsillectomy and that there were no significant changes in their serum creatinine (Cr) levels. Tamura et al (1993) found that 46% of IgAN patients with chronic tonsillitis showed a distinct improvement in their urinary findings after tonsillectomy. Akagi et al (1999) reported that remission of proteinuria in 50.0% of a group of patients 2 years after tonsillectomy.…”