Increased Urinary Excretion of Macrophage-Colony-Stimulating Factor (M-CSF) in Patients with IgA Nephropathy: Tonsil Stimulation Enhances Urinary M-CSF Excretion

Abstract

Upper respiratory tract infection including chronic tonsillitis is considered to be involved in the onset and/or the progression of IgA nephropathy. It is well known that deterioration of urinary findings occurs after episodes of upper respiratory tract infection in patients with IgA nephropathy. We previously showed that the expression of macrophage-colony-stimulating factor (M-CSF) is increased in the glomeruli of patients with IgA nephropathy and correlated with glomerular mesangial proliferation, suggesting that M-CSF plays an important role in the progression of IgA nephropathy. In the present study, we measured the serum and urinary concentrations of M-CSF in patients with IgA nephropathy associated with chronic tonsillitis. Furthermore, we evaluated the effects of the local provocation test of tonsils (mechanical tonsil stimulation) on the serum and urinary concentrations of M-CSF in the following three groups: (1) IgA nephropathy with severe mesangial proliferation, (2) IgA nephropathy with mild mesangial proliferation, and (3) patients with chronic tonsillitis without renal disease. The serum and urinary levels of M-CSF in the groups with severe and mild IgA nephropathy were significantly higher than those in the chronic tonsillitis group. The urinary M-CSF level but not the serum M-CSF level was positively correlated with the degrees of mesangial proliferation and glomerular M-CSF expression in the renal biopsy specimens. The urinary M-CSF concentration was significantly increased after tonsillitis stimulation in both mild and severe IgA nephropathy groups. Enhanced urinary excretion of M-CSF prolonged for 7 days after tonsil stimulation in the severe IgA nephropathy group; in contrast, the urinay M-CSF level was increased for only 2 days after tonsil stimulation in the mild IgA nephropathy group. The urinary M-CSF level was not changed in the chronic tonsillitis group after tonsil stimulation. The serum concentrations of M-CSF were not changed after tonsil stimulation in these three groups. Our present results suggest that tonsil stimulation contributes to the progression of IgA nephropathy via enhancement of glomerular production of M-CSF. The urinary excretion of M-CSF may be a useful predictor to evaluate the relevance of chronic tonsillitis to the disease and the indication of tonsillectomy in patients with IgA nephropathy.

Relationship between tonsils and IgA nephropathy as well as indications of tonsillectomy

“…The urinary M-CSF level was not changed in the chronic tonsillitis group after tonsil stimulation. These results suggest that tonsil stimulation contributes to the progression of IgAN via enhancement of glomerular production of M-CSF [47].…”

“…In additional, previous episodes of gross hematuria following upper respiratory tract infections and the level of serum secretory IgA were higher in IgAN patients with deterioration of urinary findings after tonsil stimulation than in those without deterioration [45]. Matsuda et al [47] evaluated the effects of the mechanical tonsil stimulation on the serum and urinary concentrations of macrophagecolony-stimulating factor (M-CSF) in patients with IgAN associated with chronic tonsillitis. The serum and urinary levels of M-CSF in the groups with mild and severe IgAN were significantly higher than those in the chronic tonsillitis group without IgAN.…”

Urinary levels of RANTES and M-CSF are predictors of lupus nephritis flare

“…There were far fewer intrarenal macrophages and T cells in M-CSF defi cient mice [31]. Although there was no study explores the correlation of intrarenal M-CSF and urinary M-CSF in patients with lupus nephritis, the study by Matsuda et al may provide evidence for that urinary M-CSF increased as intrarenal M-CSF expression elevated [32]. In our study, we found renal fl are subjects had higher urinary M-CSF and Cox analysis revealed that patients with increased urine M-CSF predisposed to renal fl are.…”

Sore Troats among the Ageing Population: a Sign of either Urinary Tract Infection or Urinary Retention?

“…Interestingly, symptoms of UTI have been found to be present in association with respiratory features, such as cough and dyspnea. A correlation between respiratory tract infections and urinary findings have already been suggested by Yamabe et al [13] and by Matsuda et al [14] who claimed that the deterioration of urinary conditions occurs after episodes of upper respiratory tract infection in patients with IgA nephropathy. An additional correlation was introduced by Barkham et al [15] who performed a retrospective analysis on 104 patients over 50 years old, and showed that a large minority of elderly patients with signs and symptoms of chest infection subsequently demonstrated proven UTI bacteremia.…”