EFFECT OF AND INDICATION FOR TONSILLECTOMY IN IGA NEPHROPATHY

Although more than 20 years have passed since the initial report of Ig A nephropathy, the etiology of this disease is still unclear. Some rep orts suggest that the tonsil is an important etiological factor. We pe rformed tonsillectomy on 26 patients with IgA nephropathy associated w ith chronic tonsillitis, and followed up the patients for two years af ter the operation to evaluate its clinical effect on this disease. Twe lve patients (efficacy rate 46%) showed distinct improvement in urinar y findings after the operation, although the efficacy rate went down a s renal injury advanced. Serum IgA levels decreased significantly afte r the operation both in patients who improved and in those who did not ; the decrease was especially evident in patients who had high levels of serum IgA before tonsillectomy. In 4 patients who improved, the lev el of circulating immune complex (CIC) was extremely high before, and decreased significantly after, the operation. One patient suffered ren al failure three years after tonsillectomy. When renal injury has adva nced to the clinically apparent degree, as occurred in this patient, t onsillectomy is absolutely contraindicated. In reaching a decision as to whether tonsillectomy is indicated in mild cases, the change in the number of erythrocytes in urinary sediments may be a sensitive parame ter of the tonsillar provocation test.