腎移植後再発ＩｇＡ腎症に施行した扁桃摘出術例

Abstract

IgA nephropathy is the most common type of glomerulonephritis, and is characterized by glomerular mesangial proliferation with predominant IgA deposition in the mesangial areas. Long-term observation showed that approximately 40% of patients with IgA nephropathy progress to end-stage renal failure after showing clinical manifestations for 20 years. In recent years, tonsillectomy in IgA nephropathy patients has become prevalent because the treatment has been found efficacious in improving renal survival.We present a case report of IgA nephropathy for which renal transplantation was performed in a 40-year-old man. The patient developed IgA nephropathy that resulted in renal graft dysfunction. To prevent disease progression, he underwent tonsillectomy under general anesthesia. The tonsillar beds were edematous and fragile, and it was very difficult to coagulate the oozing from the tonsillar beds intraoperatively. An argon beam coagulator (ABC) was found to be very useful and safe for bleeding hemostasis. After tonsillectomy, the renal function was stabilized with steroid pulse therapy.For patients progressing to end-stage renal failure, recurrent disease after transplantation remains a clinically important problem. Tonsillectomy may serve as both prophylactic and curative treatment for recurrent IgA nephropathy following renal transplantation.