Outcome of tonsillectomy for recurrent IgA nephropathy after kidney transplantation

Abstract

N. Outcome of tonsillectomy for recurrent IgA nephropathy after kidney transplantation.Abstract: Since 2007, we have performed tonsillectomies for patients with recurrent immunoglobulin A nephropathy (IgAN) after kidney transplantation. Seven patients with primary IgAN showed biopsyproven recurrent IgAN after living-donor kidney transplantation. They had persistent proteinuria or hematuria for an average of 40.3 months, and tonsillectomy was performed, on average, 75.6 months after kidney transplantation. In six patients with observation periods of more than one yr, good remission of urinary findings was observed after tonsillectomy. We classified the seven patients into three types of renal injury based on histological findings: severe, moderate, and mild. Two patients classified with severe renal injury at the time of tonsillectomy had other problems, such as refractory hypertension and bilateral sinusitis. They followed a rapidly progressive clinical course. One case already had moderate histological renal injury. He demonstrated prompt amelioration of urinary findings after tonsillectomy but immediate deviation from remission of proteinuria and hematuria. In the four cases presenting mild renal injury at tonsillectomy, the improved urinary findings and serum creatinine value after tonsillectomy have persisted.In conclusion, tonsillectomy may be a favorable treatment for cases of mild-grade IgAN. However, other treatments such as antihypertensive agents and diet therapy may be necessary in other grades.

Efficacy of tonsillectomy for the treatment of immunoglobulin A nephropathy recurrence after kidney transplantation

“…The urinary findings were improved in all patients after tonsillectomy, including a histologically severe case, for a mean period of 13.5 months [15]. Furthermore, Koshino after tonsillectomy over a mean observation period of 48.4 months [16]. In the current study, patients with tonsillectomy group exhibited improved urinary findings, whereas proteinuria increased significantly in the no tonsillectomy group.…”

“…It is also important to confirm any changes pathologically using protocol graft biopsies. However, several previous studies [14][15][16]20] did not perform long-term evaluations using protocol graft biopsies. We can also evaluate rejection according to the Banff classification and aggravation of the IgAN process for long-term observation about 10 years.…”

The value of long‐term protocol biopsies after kidney transplantation

“…In renal allografts, histological recurrence has been reported in 50–60% of patients by 5 years . Since the recurrence of IgA nephropathy is regarded as a significant cause of graft dysfunction and failure in kidney transplantation, some approaches to the treatment of recurrent IgA nephropathy have been proposed …”

“…No specific treatment for recurrent IgA nephropathy is currently available. However, three studies from Japan showed that a tonsillectomy improved clinical and histological damage in patients with IgA recurring after kidney transplantation . Hotta et al .…”

“…In contrast, in recent years, some reports have been published about post‐transplant recurrence of primary glomerulonephritis . Also, calcineurin inhibitor (CNI) nephrotoxicity remains one of the most difficult issues associated with chronic allograft damage …”