Clinicopathological study of the effectiveness of tonsillectomy in IgA nephropathy accompanied by chronic tonsillitis.

Tonsillectomy is often effective in reducing proteinuria in patients with IgA nephropathy (IgAN), which might otherwise lead to renal failure. Twenty-eight patients with IgAN accompanied by chronic tonsillitis were observed for more than 2 years after tonsillectomy and studied clinicopathologically. Tonsillectomy was effective in 17 patients (effective group), but not effective in 11 (noneffective group). Many patients in the effective group showed mild proteinuria, whereas proteinuria of 1 g/24 h or higher was found in a few cases. In comparison with the noneffective group, the levels of serum IgA, polymeric IgA and circulating immune complex (CIC) in the effective group were significantly higher prior to tonsillectomy. Histopathologically, there was only a slight increase in mesangial cells and matrixes in the effective group compared with the noneffective group, and global glomerular sclerosis, small glomerular crescents and interstitial scarring were seldom found. Rupture of the glomerular basement membrane (GBM) occurred more frequently in the noneffective than in the effective group. In a study of IgA subclasses in the mesangial area of the glomerulus, IgA1 was predominantly stained in the effective group.