The size of palatine tonsils cannot be used to decide the indication of tonsillectomy for IgA nephropathy

Abstract

Background. Tonsillectomy is one of the treatment strategies for immunoglobulin A nephropathy (IgAN). The relationship between the indication of tonsillectomy and the size of palatine tonsils (PTs) in patients with IgAN remains controversial. Methods. This retrospective cohort study investigated 57 patients with IgAN who underwent tonsillectomy combined with steroid pulse therapy (SPT). They were classified into two groups, the hypertrophy group and the nonhypertrophy group, according to the weight of their excised PTs. The effects of tonsillectomy combined with SPT on clinical remission (CR) and the histopathological findings of PTs were compared between the two groups. Results. During the mean follow-up period of 45.5 (range 6–133) months, 78.9% of the patients achieved CR (79.3 versus 78.6%, P = 0.945) and the baseline serum creatinine doubled only in one patient in the nonhypertrophy group (0 versus 3.6%, P = 0.491). No significant difference was observed in the incidence of CR between the two groups by the Kaplan–Meier method (P = 0.839). The predictor for CR, identified in Cox proportional hazards models, was baseline proteinuria [hazard ratio 0.14 (95% CI 0.032–0.621) P = 0.010]. Although macroscopic pus plugs were observed on the surface of PTs in almost 60% of patients in each group, microscopic pus plugs in the crypt and the enlarged interfollicular area were observed in all patients. Conclusions. The treatment effect of tonsillectomy combined with SPT and the pathological features of PTs in IgAN were equal, regardless of the size of the PTs. Therefore, the size of PTs should not be included as a factor when deciding the indication of tonsillectomy for IgAN.

Tonsillectomy Monotherapy for IgA Nephropathy: A Case Series

“…However, only a minority of the patients showed clinically identifiable features of recurrent tonsillitis, consistent with a recent report that tonsil size does not correlate with disease severity or the therapeutic effect of tonsillectomy in patients with IgAN. 32 …”

“…However, only a minority of the patients showed clinically identifiable features of recurrent tonsillitis, consistent with a recent report that tonsil size does not correlate with disease severity or the therapeutic effect of tonsillectomy in patients with IgAN. 32 The strengths of this study include the long-term observation of patients with slowly progressive reduction in GFR before tonsillectomy, which enabled comparison of the clinical courses before and after tonsillectomy. Consistent with previous reports, beneficial effects of tonsillectomy on urinary abnormalities and GFR decline were observed in patients with and without reduced GFR at the time of tonsillectomy.…”