Tonsillectomy for IgA nephropathy in transplanted kidneys

Abstract

　The probability of Immunoglobulin A (IgA) nephropathy recurring in a renal graft is approximately 30%. With IgA nephropathy as the primary disease, long-term renal graft prognosis is worse than with non-IgA nephropathy (with the exception of diabetic nephropathy). This “reverse phenomenon” is attributable to the influence of recurrent IgA nephropathy. Whereas one study reported that the prognosis of recurrent IgA nephropathy is often better than that of primary IgA nephropathy, other studies have revealed an unfavorable long-term prognosis or graft dysfunction within short time period. The rate of renal graft loss due to recurrence should be deemed high. After renal transplantation, steroid use is continued to prevent graft rejection; nevertheless, its onset and progression are difficult to prevent completely. The efficacy of tonsillectomy/steroid pulse therapy for recurrent IgA nephropathy in renal grafts has recently attracted attention, and numerous studies have reported generally good therapeutic outcomes. We performed tonsillectomy/steroid pulse therapy for six patients with IgA nephropathy and renal grafts at the division of Otolaryngology, Kochi Health Sciences Center (Kochi, Japan). Long-term follow-up revealed successful suppression of IgA nephropathy in all six cases. The fact that IgA nephropathy can recur in renal grafts suggests an IgA nephropathy etiology other than in the kidney. Considering the efficacy of tonsillectomy/steroid pulse therapy for the treatment of IgA nephropathy, the palatine tonsil is considered a key factor in the onset of IgA nephropathy. In the treatment of recurrent IgA nephropathy in renal grafts, tonsillectomy/steroid pulse therapy should be considered as early as possible as a therapeutic option.