title: Effect and therapeutic mechanisms of tonsillectomy for childhood IgA nephropathy.
abstract: OBJECTIVE
  We investigated efficacy and therapeutic mechanisms of tonsillectomy for intractable childhood IgA nephropathy. Five patients refused tonsillectomy. Among 25 patients, 19 patients were able to evaluate histological findings before and after surgery. Patients with poor (n = 7) or relatively poor (n = 18) histologically determined prognosis and an age of at least 7 years, together with proteinuria of at least 0.3 g/day or severe persisting despite ongoing drug treatment, are candidates for surgery. Patients were grouped by interval between diagnosis of IgA nephropathy and tonsillectomy (within 3 years; early group vs 3 years or later; later group). Patients underwent kidney biopsy shortly before and 1 to 2 years after tonsillectomy.
  
  
  RESULTS
  Proteinuria was reduced after tonsillectomy over 2 years of follow-up in both early and later groups compared with proteinuria in the 6 months preceding surgery. Complete remission was achieved in 10 patients, most often among those having surgery within 3 years, while patients refusing surgery failed to attain complete remission of urinary findings. Histological activity decreased in both groups, significantly when surgery was early. Complement component C3 deposition and activated macrophages in glomeruli decreased after tonsillectomy, especially with early surgery.
  
  
  CONCLUSIONS
  Tonsillectomy improved clinicopathological features in relatively severe paediatric IgA nephropathy, especially with the early-surgery group. Therapeutic mechanisms may include inhibition of complement activity in glomeruli and glomerular infiltration by activated macrophages.
authors.affiliation: Department of Pediatrics, Kinki University School of Medicine, Osaka, Japan.
authors.forename: Hitomi
authors.initials: H
authors.lastname: Nishi
authors.forename: Keisuke
authors.initials: K
authors.lastname: Sugimoto
authors.forename: Shinsuke
authors.initials: S
authors.lastname: Fujita
authors.forename: Kohei
authors.initials: K
authors.lastname: Miyazaki
authors.forename: Tomoki
authors.initials: T
authors.lastname: Miyazawa
authors.forename: Naoki
authors.initials: N
authors.lastname: Sakata
authors.forename: Mitsuru
authors.initials: M
authors.lastname: Okada
authors.forename: Tsukasa
authors.initials: T
authors.lastname: Takemura
mesh_terms: D000293:Adolescent; D001706:Biopsy; D016022:Case-Control Studies; D002648:Child; D003176:Complement C3 / Q000378:metabolism; D018450:Disease Progression; D005260:Female; D005922:Glomerulonephritis, IGA / Q000150:complications / Q000175:diagnosis / Q000276:immunology / Q000601:surgery*; D006801:Humans; D007150:Immunohistochemistry; D007564:Japan; D007676:Kidney Failure, Chronic / Q000209:etiology; D007678:Kidney Glomerulus / Q000276:immunology / Q000473:pathology; D008262:Macrophage Activation; D008297:Male; D011507:Proteinuria / Q000209:etiology; D012074:Remission Induction; D012720:Severity of Illness Index; D013997:Time Factors; D014068:Tonsillectomy / Q000009:adverse effects; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: C038245:C3 protein, human; D003176:Complement C3