Proteinuria-Reducing Effects of Tonsillectomy Alone in IgA Nephropathy Recurring After Kidney Transplantation

Kennoki, Takafumi; Ishida, Hideyuki; Yamaguchi, Yutaka; Tanabe, Kazunari

doi:10.1097/tp.0b013e3181b75374

Cited by 52 publications

(41 citation statements)

References 17 publications

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“…Steroid-pulse therapy can affect downstream of the immunological mechanism by suppressing the abnormal immune response in bone marrow, leading to subsequent inflammation in renal glomeruli [11]. In recurrent IgA nephropathy, some reports demonstrated that tonsillectomy alone could be an effective treatment [12,13]. Maintenance of a regimen containing steroid after renal transplantation may contribute to reducing downstream inflammation signals and immune complex deposition.…”

Section: Discussionmentioning

confidence: 99%

“…Maintenance of a regimen containing steroid after renal transplantation may contribute to reducing downstream inflammation signals and immune complex deposition. The effect of tonsillectomy was reported to be especially marked in the patients with mild mesangial changes, such as minor glomerular abnormalities when compared to patients with severe mesangial changes [12]. Akagi et al [14] proposed that tonsillectomy is indicated for patients who have renal pathology scores of HG 1 to HG 3 and a serum creatinine level of 2.0 mg/dL or less.…”

Section: Discussionmentioning

confidence: 99%

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Recurrent IgA nephropathy complicated with Crohn’s disease after renal transplantation

et al. 2014

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Recurrent IgA nephropathy complicated with Crohn’s disease after renal transplantation

et al. 2014

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“…Of the 16 and 12 patients with or without tonsillectomy during a mean follow-up period of 60 months, proteinuria decreased significantly in all tonsillectomized patients but did not in no tonsillectomy patients. No significant differences were observed in the degree of hematuria and eGFR between the groups [14]. In other study, Ushigome et al analyzed four transplant recipients with IgAN recurrence who underwent tonsillectomy.…”

Section: Discussionmentioning

confidence: 99%

“…It is also important to confirm any changes pathologically using protocol graft biopsies. However, several previous studies [14][15][16]20] did not perform long-term evaluations using protocol graft biopsies. We can also evaluate rejection according to the Banff classification and aggravation of the IgAN process for long-term observation about 10 years.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of tonsillectomy for the treatment of immunoglobulin A nephropathy recurrence after kidney transplantation

et al. 2017

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Background: Post-transplant recurrent nephritis is the third common complication that leads to graft loss, which affects the long-term graft survival of kidney transplant patients. Immunoglobulin A nephropathy (IgAN) is the most common for recurrent nephritis, with a recurrence rate of 13-53%. In this study, 12 patients diagnosed with recurrent IgAN were divided into two groups, one which underwent tonsillectomy and another which did not, to analyze the effect of treating IgAN recurrent with or without tonsillectomy. Methods: Urinary findings, estimated GFR (eGFR), and histopathological alteration (Banff and Oxford classifications) were examined for >5 years after kidney transplantation. Results: We found that tonsillectomy protected graft function and prevented pathological alterations. The levels of urinary proteins increased in the no tonsillectomy group, whereas no difference was observed in the severity of hematuria between two groups. eGFR declined and mesangial hypercellularity score increased in the no tonsillectomy group. Conclusions: Tonsillectomy not only results in a favorable clinical outcome but also protects against the histological damage caused by recurrent IgAN after kidney transplantation.

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“…A Kaplan-Meier analysis showed that the renal survival rate of the tonsillectomy group was significantly higher than in the non-tonsillectomy group, and a Cox regression analysis showed that the relative risk of terminal renal failure in the tonsillectomy group was lower than in the non-tonsillectomy group. Kennoki et al (2009) reported that in patients receiving oral immunosuppressive therapy for recurrence of IgAN after kidney transplantation, reducing of urinary protein excretion can be expected with tonsillectomy alone, without accompanying pulse steroid therapy. Wang et al (2010) recently published a meta-analysis of the clinical remission rates and long-term efficacy of tonsillectomy in IgAN patients.…”

Section: Tonsils Of Igan Patientsmentioning

confidence: 99%

Tonsillectomy and Steroid Pulse Therapy for IgA Nephropathy

Moriyama

Nitta

2011

Tohoku J. Exp. Med.

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IgA nephropathy (IgAN) is the common cause of primary glomerulonephritis worldwide. The clinical course of IgAN is extremely variable and ranges from asymptomatic microscopic hematuria to rapidly progressive renal failure. The pathogenetic mechanisms of IgAN are still unclear, but a hypothesis consisting of two pathways has been proposed. The first pathway is continuous antigenic stimulation of the innate immune system by the tonsillar mucosa via the mucosa-bone marrow axis. In the second pathway, the anomalous stimulated immune response in the bone marrow results in the production of aberrantly glycosylated IgA1 and its subsequent deposition within the mesangial area. Based on the hypothesis, tonsillectomy plus steroid pulse therapy were introduced. A recent meta-analysis showed that tonsillectomy with or without steroid pulse therapy resulted in clinical remission with favorable long-term efficacy in IgAN patients. Tonsillectomy plus steroid pulse therapy now seems to be an effective treatment for IgAN patients with hematuria and minimal proteinuria, and it is more effective in patients with less severe histological findings. The efficacy of the combination therapy depends on the duration of the IgAN. Randomized, controlled trials are needed to examine the efficacy of tonsillectomy plus steroid pulse therapy in different clinical stages of IgAN.

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Proteinuria-Reducing Effects of Tonsillectomy Alone in IgA Nephropathy Recurring After Kidney Transplantation

Abstract: These results suggest that in patients receiving oral immunosuppressive therapy for recurrence of IgA nephropathy after the kidney transplantation, reduction of the urinary protein excretion can be expected with tonsillectomy alone, without accompanying pulsed steroid therapy.

Cited by 52 publications

References 17 publications

Recurrent IgA nephropathy complicated with Crohn’s disease after renal transplantation

Recurrent IgA nephropathy complicated with Crohn’s disease after renal transplantation

Efficacy of tonsillectomy for the treatment of immunoglobulin A nephropathy recurrence after kidney transplantation

Tonsillectomy and Steroid Pulse Therapy for IgA Nephropathy

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