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ABSTRACT: To investigate the relationship between palatine tonsil and IgA nephropathy, a survey was performed by questionnaire to 154 non-ENT medical doctors who had reported case of IgA nephropathy. The questionnaire was sent in February 1997, and answers were obtained within one month from 93 doctors (79 internal physicians, 12 pediatricians and 2 pathologists); a 60.4% response rate. A total of 72.0% of doctors answered that renal pathology was the most important prognostic factor for IgA nephropathy. A total of 73.1% of doctors thought that the administration of corticosteroid was the most effective therapy for IgA nephropathy, whereas only one doctor answered that tonsillectomy was most effective. Urine protein was the most useful factor for the estimation of the treatment, according to 37.6% of doctors. The majority of doctors who replied to the questionnaire thought that palatine tonsil seemed to be involved in the pathophysiology of IgA nephropathy in less than half of patients with IgA nephropathy. In addition, they answered that the rate of patients with IgA nephropathy to whom tonsillectomy was effective was also less than 50%. The tonsillar provocation test was rarely performed for the diagnosis of tonsillar focal infection in IgA nephropathy. Furthermore, 51.6% doctors answered that urine protein was the most important factor in any estimation of the provocation test.
Nippon Jibiinkoka Gakkai Kaiho 04/1999; 102(3):305-10.
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ABSTRACT: IgA nephropathy (IgAN) is a type of chronic glomerulonephritis characterized by IgA deposits mainly in the mesangial area. It does not have so favourable a prognosis as was initially thought. This nephropathy is one of the diseases affected by tonsillar focal infections, and there have been patients in whom tonsillectomy has been effective. In this study, 24 patients with IgAN were followed for more than 2 years after tonsillectomy and studied clinicopathologically. Remission of proteinuria was observed in 41.7% of the patients 6 months after surgery and in 50.0% 2 years after surgery. At 2 years after surgery, patients with minor and focal segmental renal lesions showed a significantly higher rate of remission of proteinuria than patients with diffuse renal lesions. There was no statistically significant difference between positive and negative patients in the rate of remission of proteinuria based on any parameter of the tonsillar provocation test at any time after surgery.
Acta oto-laryngologica. Supplementum 02/1999; 540:64-6.
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M Matsuda,
K Shikata,
J Wada,
H Yamaji,
Y Shikata, A Doi,
M Kosaka,
H Akagi,
Y Masuda,
Y Ohmoto,
H Makino
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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.
Nephron 02/1999; 81(3):264-70. · 13.26 Impact Factor
