Abstract
The IgA nephropathy (IgAN) is a very common glomerulonephritis and can result in end-stage renal disease. From a clinical point of view, IgAN is characterised by repeated events of macrohaematuria associated with infections of the upper airways. In IgAN, the IgA released by the tonsillar lymphatic tissue into blood circulation are defective in glycosylation. These aberrant IgA can reach the glomeruli and deposit into mesangium causing an inflammation with cellular proliferation. The treatment is not yet well defined: steroids and immunosuppressive drugs are suggested in cases with a progressive disease. Tonsillectomy was proposed to reduce the infective events of upper airways and the lymphatic tissue producing undergalactosylated IgA. The experiences in literature coming from Asia report positive effects of tonsillectomy on IgAN. In patients with tonsillectomy, the renal signs improved (less haematuria and proteinuria) and the renal outcome was better (slower progression of renal damage). These were uncontrolled studies and tonsillectomy was associated with steroid and immunosuppressive treatment, so it is not possible to tell the real effect of tonsillectomy. In contrast, the European studies reported that the tonsillectomy was not associated with a better outcome of IgAN. A critical review of the subject reveals that most of the papers with positive results were uncontrolled retrospective experiences, while in a randomised controlled trial paper the advantages of tonsillectomy disappeared. In conclusion, this review, in agreement with the international guidelines, concludes that tonsillectomy does not play any role in the progression of IgAN.
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References
Wyatt RJ, Julian BA (2013) IgA nephropathy. N Engl J Med 368(25):2402–2414
Donadio JV, Grande JP (2002) IgA nephropathy. New Engl J Med 347(10):738
Berthoux FC, Mohey H, Afiani A (2008) natural history of primary IgA nephropathy. Seminars Nephrol 28:4–8
Haas M (2007) IgA nephropathy and Henoch-Schonlein purpura in Heptinstall’s Pathology of the kidney. In: Jennette J, Olson J, Schwartz M, Silva F (eds) 6th edn. Lippincott Williams & Wilkins, philadelphia
A working Group of the International IgA Nephropathy Network and the Renal Pathology (2009) The Oxford classification of IgA nephropathy: rationale, clinicopathological correlations, and classification. Kidney Int, pp 534–43
VALIGA study of the ERA-EDTA Immunonephrology Working Group (2014) Validation of the Oxford classification of IgA nephropathy in cohorts with different presentations and treatments. Kidney Int 86(4):828–836. doi:10.1038/ki.2014.63
KDIGO 2012 (2013) Clinical Practice Guideline for the Evaluation and Management. Kidney Int 3
Goto M, Wakai K, Kawamura T et al (2009) A scoring system to predict renal outcome in IgA nephropathy: a nation wide 10 years prospective cohort study. Nephrol Dial Transpl 24:3068–3074
Coppo R, Peruzzi L, Amore A et al (2007) IgACE a placebo controlled randomized trial of angiotensin converting enzyme inhibitors in children and young people with IgAN and a moderate proteinuria. J Am Soc Nephrol 18:1880–1888
Pozzi C, Andrulli S, Del Vecchio L et al (2004) Corticosteroid effectiveness in IgAN: long–term results of a randomisez controlled trial. J Am Soc Nephrol 15:157–163
Béné MC, Faure GC, Hurault de Ligny B et al (2004) Clinical involvement of the tonsillar immune system in IgA nephropathy. Acta Otolaryngol Suppl
Novak J, Julian BA, Mestecky J et al (2012) Glycosilation of IgA1 and pathogenesis of IgA nephropathy. Semin Immunopathol 34:365–382
Hiki Y, Akihiko A, Yamamoto Y et al (2011) IgA nephropathy and aberrant glycpsylation of tonsillar, serum and glomerular IgA1. Adv Otorhinolaryngol 72:68–70
Rasmussen SB, Reinert LS, Paludan SR (2009) Innate recognition of intracellular pathogens: detection and activation of the first line of defense. APMIS. 117:323–337
Hellings P, Jorissen M, Ceuppens JL (2000) The Waldeyer’s ring. Acta Otorhinolaryngol 54:237–241
Woof JM, Russel MW (2011) Structure and function relationships in IgA. Mucosal Immunol 4:590–597
Novak J, Moldoveanu Z, Julian BA et al (2011) Aberrant glycosylation of IgA1 and anti-glycan antibodies in IgA nephropathy: role of mucosal immune system. Adv Otorhinolaryngol 72:60–63
Lai KN (2012) Pathogenesis of IgA nephropathy. Nat Rev Nephrol 8:275–283
Canetta PA, Krzysztof K, Appel GB (2014) Glomerular diseases: emerging tests and therapies for IgA nephropathy. Clin J Am Soc Nephrol 9:617–625
Johansson E, Hultcrantz E (2003) Tonsillectomy- clinical consequences twenty years after surgery? Inter Pediatrics Otorhin. 67:981–988
Suzuki Y, Suzuki H, Nakata J (2011) Pathological role of tonsillar B cells in IgA nephropathy. Clinical Dev Immunol 2011:639074. doi:10.1155/2011/639074
Xie Y, Chen X, Nishi S, Narita I et al (2004) Relationship between tonsils and IgA nephropathy as well as indications of tonsillectomy. Kidney Int 65:1135–1144
Zielnik-Jurkiewicz B, Jurkiewicz D (2002) Implication of immunological abnormalities after adenotonsillotomy. Int J Pediatr Otorhinolaryngol 64:127–132
Zand L, Fervenza FC (2014) Does tonsillectomy have a role in the treatment of patients with immunoglobulin A nephropathy?. Nephrol Dial Transpl
Vergano L, Loiacono E, Albera R et al (2015) Can tonsillectomy modify the innate and adaptive immunity pathways involved in IgA nephropathy? J Nephrol 28:51–58
Santos FP, Weiber R, Fortes BC et al (2013) Short and long term impact of adenotonsillectomy on the immune system. Braz J Otorhinolaryngol 79(1):28–34
Tamura S, Masuda Y, Inokuchi I et al (1993) Effect of and indication for tonsillectomy in IgA nephropathy. Acta Otoryngol Suppl 508:23–28
Komatsu H, Fujimoto S, Hara S et al (2008) Effect of tonsillectomy plus steroid pulse therapy on clinical remission of IgA nephropathy: a controlled study. Clin J Am Soc Nephrol 3:1301–1307
Piccoli A, Codognotto M, Tabbi MG et al (2010) Influence of tonsillectomy on the progression of mesangioproliferative glomerulonephritis. Nephrol Dial Transpl 25:2583–2589
Xie Y, Nishi S, Ueno M et al (2003) The efficacy of tonsillectomy on long-term renal survival in patients with IgA nephropathy. Kidney Int 63:1861–1867
Maeda I, Hayashi T, Sato KK et al (2012) Tonsillectomy Has beneficial effects on remission and progression of IgA nephropathy independent of steroid therapy. Nephrol Dial Transplant 27:2806–2813
Kawaguchi T, Ieiri N, Yamazaki S et al (2010) Clinical effectiveness of steroid pulse therapy combined with tonsillectomy in patients with immunoglobulin A nephropathy presenting glomerular hematuria and minimal proteinuria. Nephrology 15:116–123
Rasche FM, Schwarz A, Keller F (1999) Tonsillectomy does not prevent a progressive course in IgA nephropathy. Clin Nephrol 51:147–152
Yamamoto Y, Hiki Y, Nakai NS et al (2013) Comparison of effective impact among tonsillectomy alone, tonsillectomy combined with oral steroid and with steroid pulse therapy on long-term outcome of immunoglobulin A nephropathy. Clin Exp Nephrol 17:218–224
Chen Y, Tang Z, Wang Q et al (2007) Long-term efficacy of tonsillectomy in Chinese patients with IgA nephropathy. Am J Nephrol 27:170–175
Kawamura T, Yoshimura M, Miyazaki Y et al (2014) A multicenter randomized trial of tonsillectomy combined with steroid pulse therapy in patients with immunoglobulin A nephropathy. Nephrol Dial Transpl 29:1546–1553
Hotta O, Miyazaki M, Furuta T et al (2001) Tonsillectomy and steroid pulse therapy: tonsillectomy and steroid pulse therapy significantly impact on clinical remission in patients with IgA nephropathy. Am J Kidney Dis 38:736–743
Miura N, Imai H, Kikuchi S, Hayashi S (2009) Tonsillectomy and steroid pulse (TSP) therapy for patients with IgA nephropathy; a national wide survey of TPS therapy in Japanese and an analysis of the predictive factors for resistance to TSP therapy. Clin Exp Nephrol 13:460–466
Kent D, Tazeen H, Hayard R (2007) Progression risk, urinary protein excretion and treatment effects of angiotensin converting enzyme inhibitors in nondiabetic kidney disease. J Am Soc Nephrol 18:1959–1965
Tsuchiya T, Ito S, Yamaguchi Y et al (2010) Tonsillectomy and steroid pulse therapy for recurrent IgA nephropathy in renal allograft. Clin Nephrol 64:68–71
Coppo R (2010) Can a dysregulated mucosal immune system in IgA nephropathy be controlled by tonsillectomy? Nephrol Dial Transplant 25:2395–2397
Ponticelli C (2012) Tonsillectomy and IgA nephritis. Nephrol Dial Transpl 27:2610–2613
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Feriozzi, S., Polci, R. The role of tonsillectomy in IgA nephropathy. J Nephrol 29, 13–19 (2016). https://doi.org/10.1007/s40620-015-0247-4
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DOI: https://doi.org/10.1007/s40620-015-0247-4