Clinical remission of Henoch–Schönlein purpura nephritis after a monotherapeutic tonsillectomy

Abstract

We herein describe an adult male patient who presented with tonsillitis, purpura, hematuria, and proteinuria. The serological analyses revealed elevated serum antistreptolysin, and the throat culture yielded Lancefield group A β-hemolytic streptococci. A renal biopsy revealed mild mesangial proliferation associated with granular mesangial depositions of IgA and C3, consistent with Henoch-Schönlein purpura nephritis (HSPN). Initially, the patient was treated with dipyridamole, which was followed by limited improvements in the proteinuria and hematuria. Nine months later, the tonsillitis relapsed due to GAS infection and deteriorated urinary abnormalities were noticed, which finally disappeared after monotherapeutic tonsillectomy. Although the impact of tonsillectomy on the treatment of HSPN remains to be characterized, our observations suggest that tonsillectomy in the present patient played a pivotal role in facilitating the recovery of the renal injuries. Because the arbitrary application of a tonsillectomy appears to be accompanied by ethical concerns, the evaluation of the clinical benefits of this procedure should be addressed more directly in the future.

Successful treatment of recurrent Henoch–Schönlein purpura nephritis in a renal allograft with tonsillectomy and steroid pulse therapy

“…However, these treatments had no effect on her native kidney. There are some reports from Japan that a tonsillectomy followed by steroid pulse therapy resulted in decreased proteinuria and improved renal function and pathological findings of HSPN in the native kidney or recurrent IgA nephropathy in a renal allograft . In this context, we believed our patient was refractory to the additional immunosuppressant and plasmapheresis and decided to perform a tonsillectomy followed by steroid pulse therapy.…”

“…Therapy for severe HSPN usually involves methylprednisolone pulse therapy with oral corticosteroids, immunosuppressive agents, antiplatelet drugs, and plasmapheresis. Tonsillectomy has also been used in some HSPN patients, with a marked improvement in renal function and proteinuria, but its benefit in the setting of recurrent disease in a renal allograft has not been reported. To our knowledge, this is the first report of the efficacy of tonsillectomy and steroid pulse therapy in a kidney transplant patient who developed active HSPN.…”

Successful therapy with tonsillectomy for severe ISKDC grade VI Henoch–Schönlein purpura nephritis and persistent nephrotic syndrome

“…Furthermore, Iwazu et al [15] reported that a monotherapeutic tonsillectomy was effective in inducing the clinical remission of HSPN. We have previously reported the effectiveness of tonsillectomy plus pulse therapy as a rescue therapy in an 11-year-old boy with HSP with recurrent purpura and persistent nephropathy [13].…”

“…As to the efficacy of tonsillectomy for HSPN, we reviewed 5 cases in which tonsillectomy was performed for HSPN including adults and children, and examined the epidemiology, clinical signs, treatment, and prognosis [12][13][14][15]. These published reports are listed in Table 1.…”