Histological correlation between tonsillar and glomerular lesions in patients with IgA nephropathy justifying tonsillectomy: A retrospective cohort study

15^th World Nephrology Conference

April 16-17, 2025 | Tokyo, Japan

Kensuke Joh

The Jikei University School of Medicine, Tokyo, Japan

Keynote: J Nephrol Ther

Abstract :

Tonsillectomy with steroid pulse therapy (SPT) has been established as an effective treatment for immunoglobulin A nephropathy (IgAN) in Japan. However, the underlying mechanisms supporting tonsillectomy remain unclear. This study assessed palatine tonsils from 77 patients withã??IgAN, including 14 and 63 who received SPT before and after tonsillectomy, respectively. Tonsils fromã??21 patients with chronic tonsillitis were analyzed as controls. Specific tonsillar lesions were confirmed in patients with IgAN, correlating with active or chronic renal glomerular lesions and SPT. T-nodule and involution of lymphoepithelial symbiosis scores in tonsils correlated with the incidence of active crescents and segmental sclerosis in the glomeruli, respectively. The study revealed an essential role of the tonsilâ??glomerular axis in early active and late chronic phases. Moreover, the SPT-preceding group demonstrated no changes in the T-nodule score, which correlated with active crescent formation, but exhibited a considerable shrinkage of lymphatic follicles that produced aberrant IgA1. The study underscores the involvement of innate and cellular immunity in IgAN and advocates for tonsillectomy as a necessary treatment alongside SPT for IgAN, based on a stepwise process.

Biography :

Kensuke Joh is working as professor in department of pathology at the Jikei University School of Medicine in Tokyo, Japan. He also works as a visiting professor at department of pathology in Tohoku University Graduate School of Medicine. His current and previous research interests are clinicopathological study on IgA nephropathy.