IgA Nephropathy with Poorly Developed Lymphoepithelial Symbiosis of the Palatine Tonsils

Abstract

Tonsillar abnormalities have been observed in patients with IgA nephropathy (IgAN). In addition, it has been suggested that reticulization of tonsillar crypt epithelium is important in tonsillar immunity. Therefore, we investigated reticulization of this area in patients with IgAN (14 cases) and compared results with those of control patients who exhibited recurrent tonsillitis or tonsillar hypertrophy (12 cases). Immunohistochemical staining of antikeratin antibody PKK1 was employed to visualize reticulization. Tonsils of controls showed well developed reticular crypt epithelia with lymphoepithelial symbiosis and the nonreticulated area was less than 7% of the total crypt epithelia per overall section. In IgAN tonsils, however, nonreticulated crypt epithelium was frequently observed and, in the advanced stage of IgAN, exceeded 50% of total crypt epithelia. The extent of glomerular damage in IgAN patients correlated significantly with the percentage of the area of nonreticulated crypt in palatine tonsils with a correlation coefficient of 0.91. Considered together with our finding that PKK1 -positive epithelial reticular cells strongly expressed HLA-DR antigens in normal tonsils, the low level of reticulization in IgAN patients may induce the unusual immunity responsible for the pathogenesis of IgAN.

Cohort Study of Advanced IgA Nephropathy: Efficacy and Limitations of Corticosteroids with Tonsillectomy

“…To determine histological severity, two nephrologists with extensive experience in the diagnosis of IgAN assessed six features: glomerular sclerosis, crescents, tubular atrophy, interstitial fibrosis, interstitial infiltrate, and vascular sclerosis. They evaluated the glomerular sclerosis using the index of the glomerular lesion (IGL) according to the method originally proposed by Suwa and Takahashi [14]with a modification as previously described [15](fig. 1).…”

Significance of the duration of nephropathy for achieving clinical remission in patients with IgA nephropathy treated by tonsillectomy and steroid pulse therapy

“…The baseline characteristics included age, sex, blood pressure (BP), estimated glomerular filtration rate (eGFR), degree of proteinuria, urinary red blood cell (URBC) count, and histological features [severity of glomerular lesions, percentage of necrotizing and/or crescent lesions (NC lesions), and severity of tubulointerstitial changes (TI changes), including severity of tubular atrophy, interstitial mononuclear cell infiltration, and interstitial fibrosis]. Severity of glomerular lesions was evaluated using the index of glomerular lesions (IGL) according to the method originally proposed by Suwa and Takahashi [15], with a previously described modification to evaluate sclerotic changes [16][17][18].…”

Tonsillectomy and Steroid Pulse Therapy for IgA Nephropathy

“…The tonsils of control patients with recurrent tonsillitis or tonsillar hypertrophy showed well-developed reticular crypt epithelia with lymphoepithelial symbiosis, and the non-reticulated area accounted for less than 7% of the total crypt epithelium. However, non-reticulated crypt epithelium is frequently observed in the tonsils of IgAN patients, and it exceeds 50% of the total crypt epithelium in the advanced stage of IgAN (Sato et al 1996). Table 1 summarizes the effects of tonsillectomy for IgAN.…”