title: Beneficial effects of tonsillectomy for mesangial immunoglobulin A (IgA) deposition and clinical outcome in five kidney transplant patients with recurrent IgA nephropathy: case report.
abstract: BACKGROUND
  Tonsillectomy has been applied for recurrent immunoglobulin (Ig)A nephropathy (IgAN) in kidney transplantation recipients, but allograft histologic changes after this treatment remain unclear.
  
  
  METHODS
  Five patients with recurrent IgAN underwent tonsillectomy for persistent proteinuria (average, 397.2 mg/d; >6 months). Six repeated biopsies were taken 33.8 ± 17.1 months after treatment. Glomerular IgA deposition was detected by immunofluorescence staining on frozen tissue. Histologic and clinical data have been collected.
  
  
  RESULTS
  An average of 11.2 months (range, 6-20) after tonsillectomy, proteinuria decreased to 60.8 ± 49.3 mg/d. Serum creatinine (SCr) slightly decreased (1.33 ± 0.31 before vs 1.24 ± 0.29 after treatment; P > .05). In 5 of the 6 repeated biopsy samples month after tonsillectomy, there was decreased mesangial IgA deposition. Glomerular crescent and endothelial proliferation were no longer found, although there was increased focal sclerosis and adhesion. After tonsillectomy, there were increased interstitial fibrosis and tubular atrophy, with no significant differences in Banff scores.
  
  
  CONCLUSIONS
  Tonsillectomy can reverse not only persistent proteinuria, but also mesangial IgA deposition in patients with recurrent IgAN. Tonsillectomy may have both favorable clinical and histologic effects in recurrent IgAN after kidney transplantation.
authors.affiliation: Department of Advanced Technology for Transplantation, Osaka University Graduate School of Medicine, Osaka, Japan; Department of Urology and Kidney Transplantation, Affiliated First Hospital, Shanghai Jiaotong University, Osaka, Japan.
authors.forename: Y
authors.initials: Y
authors.lastname: Wang
authors.affiliation: Department of Advanced Technology for Transplantation, Osaka University Graduate School of Medicine, Osaka, Japan. Electronic address: ichimaru@att.med.osaka-u.ac.jp.
authors.forename: N
authors.initials: N
authors.lastname: Ichimaru
authors.affiliation: Sakurabashi Iseikai Clinic, Osaka, Japan.
authors.forename: M
authors.initials: M
authors.lastname: Kyo
authors.affiliation: Department of Specific Organ Regulation (Urology), Osaka University Graduate School of Medicine, Osaka, Japan.
authors.forename: Y
authors.initials: Y
authors.lastname: Kakuta
authors.affiliation: Department of Specific Organ Regulation (Urology), Osaka University Graduate School of Medicine, Osaka, Japan.
authors.forename: M
authors.initials: M
authors.lastname: Okumi
authors.affiliation: Department of Advanced Technology for Transplantation, Osaka University Graduate School of Medicine, Osaka, Japan.
authors.forename: J Y
authors.initials: JY
authors.lastname: Kaimori
authors.affiliation: Department of Specific Organ Regulation (Urology), Osaka University Graduate School of Medicine, Osaka, Japan.
authors.forename: N
authors.initials: N
authors.lastname: Nonomura
authors.affiliation: Department of Urology and Kidney Transplantation, Affiliated First Hospital, Shanghai Jiaotong University, Osaka, Japan.
authors.forename: Y
authors.initials: Y
authors.lastname: Fan
authors.affiliation: Department of Advanced Technology for Transplantation, Osaka University Graduate School of Medicine, Osaka, Japan.
authors.forename: S
authors.initials: S
authors.lastname: Takahara
mesh_terms: D000328:Adult; D005260:Female; D005920:Glomerular Mesangium / Q000378:metabolism*; D005922:Glomerulonephritis, IGA / Q000601:surgery*; D006801:Humans; D007070:Immunoglobulin A / Q000378:metabolism*; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D014068:Tonsillectomy; D016896:Treatment Outcome
chemical_list: D007070:Immunoglobulin A