[The effect of tonsillectomy on the level of circulating immune complexes and urine changes in patients with glomerulonephritis].
The influence of tonsillectomy on circulating immune complexes (C.I.C.) level, proteinuria and erythrocyturia was studied in 42 patients with chronic tonsillitis (Ch.T.) and urine abnormalities. The level of C.I.C. was examined by two methods: the 3.5% polyethyleneglycol (PEG) precipitation method and the 125I-C1q binding method. After tonsillectomy, bacteriological analysis of removes facial tonsilla was performed in 7 patients and morphological analysis in 11. Renal biopsy was done in 28 patients. The control group was consisted of 18 patients with Ch.T. without urine abnormalities. The presence of C.I.C. was established in 48% of patients with urine abnormalities using PEG method and in 33% with 125I-C1q binding method. Mean values of C.I.C. in patients with proteinuria or erythrocyturia were statistically higher than in the control group. After tonsillectomy, transitory increase of C.I.C. level was observed in 60% of patients, accompanied by augmentation in urine changes, especially proteinuria. During one year of observation, significant decrease in C.I.C. levels detected by PEG method, as well as in proteinuria and in erythrocyturia was found. In 10 patients urine abnormalities disappeared. No differences between both groups of patients were found in the results of bacteriological and morphological studies of removed tonsilla. However, the normalisation of urine changes was noticed in patients without hypertension and in whom renal disease did not exceed two years. Renal histology revealed mesangocapillary proliferative Gn in 14, mesangial proliferative Gn in 11, and focal/segmental glomerulosclerosis in 3 patients. In one patient with mesangial proliferative Gn complete retreat of urine changes was observed. We suggest that the presence of Ch.T. influences on the C.I.C. detectability in patients with chronic glomerulonephritis. The tonsillectomy can lead do the decrease of C.I.C. levels, as well as to the decrease of proteinuria and/or erythrocyturia. Serum C.I.C. examination seems to be helpful in qualifying patients with Ch.T. for tonsillectomy, in immunological monitoring after the operation and in later prognosis in case of chronic glomerulonephritis.
Oko
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Kliniki Nefrologii Instytutu Chorób Wewnetrznych Akademii Medycznej w Poznaniu.
Niemir
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Krzymański
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D000293:Adolescent; D000328:Adult; D000936:Antigen-Antibody Complex / Q000097:blood*; D001706:Biopsy; D002908:Chronic Disease; D004906:Erythrocyte Count; D005260:Female; D005500:Follow-Up Studies; D005921:Glomerulonephritis / Q000150:complications* / Q000276:immunology / Q000473:pathology / Q000652:urine; D006417:Hematuria / Q000209:etiology / Q000517:prevention & control*; D006801:Humans; D007668:Kidney / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011507:Proteinuria / Q000209:etiology / Q000517:prevention & control*; D014068:Tonsillectomy; D014069:Tonsillitis / Q000150:complications / Q000276:immunology* / Q000601:surgery* / Q000652:urine; D014556:Urine / Q000737:chemistry / Q000166:cytology
D000936:Antigen-Antibody Complex