Tonsillectomy ameliorates histological damage of recurrent immunoglobulin A nephropathy after kidney transplantation

AimRecurrence of immunoglobulin A (IgA) nephropathy (IgAN) after renal transplantation is important as a cause of graft failure under improving rejection control. However, no specific therapy for recurrent IgAN is currently available. In this study, we evaluated the histological efficacy of tonsillectomy for allograft IgAN. MethodsFifteen kidney recipients (male 9, female 6, mean age 40.99.3 years), who received a diagnosis of IgA nephropathy by allograft biopsy, were enrolled in this study. Tonsillectomy was performed 44.127.1 months after the kidney transplantation. All patients underwent a repeat graft biopsy at 23.815.8 months after tonsillectomy. ResultsSix patients had microhematuria before tonsillectomy. At 12 months after treatment, the microhematuria disappeared in five of these patients and one patient had mild hematuria. Three patients had severe proteinuria (more than 1.0g/gCr) before tonsillectomy and improved after treatment. On histological analysis, four patients had acute lesions including cellular or fibrocellular crescents. The acute lesions disappeared after these treatments in all patients. Eleven patients had chronic lesions including global sclerosis, segmental sclerosis and fibrous crescents. The chronic lesion was ameliorated in six patients, unchanged in three and deteriorated in two patients. ConclusionsTonsillectomy improves not only clinical findings but also ameliorates histological damage caused by recurrent IgAN after kidney transplantation. Tonsillectomy is a novel and effective treatment for recurrent IgAN. Summary at a Glance Tonsillectomy improves clinical and histologic parameters in 15 Japanese patients with recurrent IgA nephropathy after kidney transplant. The availability of repeat biopsy in all patients is a strength of this study, while the lack of a control group is a drawback.