Pathologic tonsillar findings similar to IgA nephropathy and the role of tonsillectomy in a patient with nephrotic syndrome

• Published in: BMC nephrology 2019-10, Vol.20 (1), p.381-381, Article 381
• Main Authors: Enya, Takuji, Miyazawa, Tomoki, Miyazaki, Kohei, Oshima, Rina, Morimoto, Yuichi, Okada, Mitsuru, Takemura, Tsukasa, Sugimoto, Keisuke
• Format: Article
• Language: English
• Subjects: Adult; Care and treatment; Case Report; Case studies; CD4-Positive T-Lymphocytes - pathology; Chronic Disease; Diagnosis; Epithelium; Frequently relapsing nephrotic syndrome; Glomerulonephritis, IGA - pathology; Humans; Iga glomerulonephritis; Immunoglobulin A; Immunohistochemistry; Immunosuppressive agents; Kidney diseases; Lymphocytes; Male; Medical research; Nephrotic syndrome; Nephrotic Syndrome - complications; Nephrotic Syndrome - surgery; Novels; Palatine Tonsil - pathology; Patient outcomes; Recurrence; Regulatory T cells; Self-tolerance; T cells; Tonsillectomy; Tonsillitis; Tonsillitis - complications; Tonsillitis - pathology; Tonsillitis - surgery
• ISSN: 1471-2369; 1471-2369
• DOI: 10.1186/s12882-019-1580-y

The pathological findings of tonsils in IgA nephropathy include the expansion of T-cell nodules around lymphoid follicles and abnormal reticulation of the crypt epithelium in contrast to chronic tonsillitis. Recently, several studies have reported that regulatory T cells play an important role in the maintenance of self-tolerance, an abnormality that is involved in the onset of nephrotic syndrome (NS). We encountered a patient of 28-year-old male with frequently relapsing nephrotic syndrome (FRNS) and chronic tonsillitis whose tonsils demonstrated pathological findings similar to those of IgA nephropathy. A patient had developed NS at the age of 5 years, and was pathologically diagnosed with minimal change disease (MCD), for which he received various immunosuppressive agents as treatment for recurrence. Because tonsillitis often triggers the recurrence of NS, a tonsillectomy was performed for chronic tonsillitis at the age of 25 years. Immunohistochemical staining of his tonsils showed the expansion of CD4 positive lymphocytes around the lymphoid follicles and abnormal reticulation of the crypt epithelium. The number of peripheral blood CD4 CD25 regulatory T cells increased, and the frequency of relapses decreased after tonsillectomy. A similar self-tolerance abnormality exists in NS and IgA nephropathy; therefore, tonsillectomy might become a novel therapeutic approach for FRNS to redress the unbalanced self-tolerance and to remove the tonsillar focal infection. Further studies are necessary to verify the clinical efficiency of tonsillectomy for FRNS with recurrent episodes triggered by tonsillitis.