Role of tonsillectomy in the management of IgA nephropathy

Abstract

Background :The tonsils represent a site of local immunity where immunoglobulin-bearing cells are capable of producing IgA. The tonsils have been considered the foci of abnormal IgA production in IgAN, thus, a relationship is suggested between the tonsillar immune response and the pathogenesis of IgAN. IgAN, then, is considered a tonsillar focal infection. Patients and methods :This study was done on 15 patients their ages ranged between 15 and 35 (10 males and 5 females). All patients were already diagnosed by renal biopsy-proven IgA nephropathy by the nephrologists and under medical treatment by conventional steroid. The diagnosis of IgA nephropathy was based on histologic assessment of percutaneous renal biopsy tissue. The main problem in all patients is that development of gross haematoria, deterioration of urinary findings and deterioration of the general condition of the patient after any acute attack of upper respiratory tract infection especially acute tonsillitis. Tonsillectomy was done after one month from controlling the acute infection. Postoperative follow up for all patients was done at 1st, 3rd, 6th, 12th month by clinical examination and laboratory investigations Results :The gross haematoria was completely stopped in all patients after tonsillectomy except two patients one of them was complicated by hypertension and the other one was complicated by nephritic syndrome. Also there was marked reduction in proteinuria, microscopic haematoria, marked reduction in the serum IgA concentration, urinary abnormalities disappeared and also improvement of renal function for the patients with serum creatinin less than 2mg/dl while in the two patients with serum creatinin more than 2mg/dL there was no much improvement after tonsillectomy with more deterioration of renal function of both patients with the development of chronic renal failure in the patient with nephritic syndrome 9 month postoperative Conclusion :Tonsillectomy is effective in improving renal function ,urinary symptoms, gross haematoria and decreasing the level of IgA in patients with IgAN if it is done in mild to moderate cases with serum creatinin less than 2mg/dL while has no much efficacy on moderate to severe cases with serum creatinin more than 2mg/dL or complicated cases.