Microalbuminuria as renal marker in recurrent acute tonsillitis and tonsillar hypertrophy in children

Raised levels of microalbuminuria pointing out glomerular abnormality and indicate renal damage. Glomerulonephritis is caused by immune reaction leading to the formation of circulating immune complexes that are deposited on the basal membrane of the glomerulus. The time course and the appearance of antibodies against infectious agents both play very important roles in its clinical presentation. Antibodies against streptococci have not a protective role, but offers a useful marker of the presence or absence of recent infection. This work studies the presence of microalbuminuria and circulating anti-streptococcal antibodies, namely, anti-streptolysin O and anti-deoxyribonuclease B antibodies in ninety children which underwent tonsillectomy due to infectious and obstructive tonsillar pathology. These children were divided in recurrent acute tonsillitis (n= 34), recurrent tonsillitis with tonsillar hypertrophy (n = 26), and tonsillar hypertrophy (n = 30). It was found in recurrent acute tonsillitis a moderate correlation between microalbuminuria and anti-streptolysin O, and a weak correlation between microalbuminuria and anti-deoxyribonuclease B antibodies. It was also found significant differences of the levels of anti-streptococcal antibodies between the three groups of pathologies. It is proposed the determination of microalbuminuria, an inexpensive and harmless test, as an indicator of possible renal damage in recurrent acute tonsillitis.     

Detection tonsillar pathology by superoxide dismutase levels. Comparative study of surgical indications for tonsillectomy

If oxygen-derived free radicals are considered the definitive cause of tonsillar damage after infection, it seems reasonable that scavenger antioxidants levels could be used as a detector of tissue impairment. So, superoxide dismutase (SOD) amounts were measured in palatine tonsils and peripheral blood on subjects bearing of hypertrophy without infection (H, n = 83), recurrent tonsillitis (RA, n = 75), and peritonsillar abscess (PA, n = 12). SOD levels in both tonsillar cultures supernatants and peripheral blood erythrocytes were detected progressively increased in groups with H, RA and PA, which were statistically significative (ANOVA-test; p < 0.001). A significative correlation between tissue and blood was observed for all the groups. We can conclude that SOD concentration in palatine tonsils and/or peripheral blood increases proportionally to infections incidence, which allows detecting patients with functional damage, and recommending objectively tonsillectomy or at least monitoring clinical response for a therapy. Practical use and results obtained from comparison to tonsil biopsies are discussed.     

Tonsillar microbial flora: comparison of recurrent tonsillitis and normal tonsils

Tonsillar microbial flora was studied in cultures of tonsillar core specimens from 34 patients tonsillectomized due to recurrent group A streptococcal pharyngotonsillitis (n = 17) or sleep apnoea (n = 17). Patients in the sleep apnoea subgroup, who had no history of recurrent tonsillitis and manifested no tonsillar hypertrophy at ENT examination, served as controls. Tonsillar core specimens were cultured for semi-quantitative estimation of growth of aerobic, anaerobic and facultative organisms. The recurrent tonsillitis and apnoea subgroups did not differ significantly in the mean number of isolates per patient, either of aerobic spp. (3.8 vs. 4.3) or anaerobic spp. (5.2 vs. 4.7). Nor did the two subgroups differ significantly in the proportion of patients whose specimens manifested beta-lactamase producers (71% vs. 59%), in the isolation frequency of viridans (alpha) streptococci, or in the occurrence of semi-quantitative growth estimates of 3-4+ for aerobic, anaerobic or beta-lactamase-producing spp. Thus, the study provided no support for the hypothesis that inactivation of penicillin V by beta-lactamase-producing bacteria in oral or throat flora, or the eradication of viridans streptococci with their GAS-inhibitory capacity, is an important factor with regard to recurrent group A streptococcal tonsillitis. Other possible explanations, such as poor antibiotic penetration at the site of infection, are discussed.     

Oxidative profile of tonsil infection. Study of antioxidant enzymes in tonsil and blood

In order to investigate the effect of oxidative damage due to free radicals on ENT infectious diseases, levels of superoxide dismutase (SOD), glutathione-peroxidase (GPx) and reductase (GRt) and the total antioxidant status (TAS) were measured by spectrophotometry on tonsillar tissue obtained from tonsillectomy in 538 patients, who were divided in three groups according to their surgical indication: tonsillar hypertrophy (n = 235), recurrent tonsillitis (n = 280) or peritonsillar abscess (n = 23). SOD concentration were also measured on adenoid tissue and middle ear exudate in 75 patients from the first two groups. Erythrocyte and tonsillar SOD levels were significantly greater in the abscess group, and lower in the hypertrophic one. These differences were similar for GPx and TAS. For GRt, its level in abscess were lower than in the other two groups in a statistically significant way. There were strong correlations between erythrocyte and tonsillar SOD, tonsillar SOD and GPx, tonsillar SOD and TAS, and tonsillar GPx and TAS. SOD concentrations from adenoid tissue and middle ear exudate did not affect its blood level. So, we can conclude that tonsillar oxidative damage is determined by the frequency or the severity of local infections, and it can be evaluated by measuring the SOD concentration in the tonsillar tissue or in the peripheral blood. So, it can be considered a good marker of tonsillar damage.     

Variations of salivary dismutase superoxide in tonsillar infection

The antioxidant effect of superoxido dismutase in saliva was measured in children bearing of tonsillar hypertrophy, recidivant tonsillitis or peritonsillar abscess. These levels were compared to those detected on tonsillar tissue obtained from tonsillectomy (p < 0.001). Although salivary SOD concentration in children with tonsillar infection was higher than hypertrophy, there was not a significative correlation to tonsillar value of the enzyme (R2 = 0.2276), so we can not accept a predictive value for salivary SOD of tonsillar suffering and, eventually, of tonsillectomy.     

High recovery of Haemophilus influenzae and group A streptococci in recurrent tonsillar infection or hypertrophy as compared with normal tonsils

One hundred and twenty-six patients who underwent tonsillectomy because of recurrent acute tonsillitis, tonsillar hypertrophy or sleep apnoea were evaluated by tonsillar core culturing. The sleep apnoea patients served as controls, since none of them had tonsillar hypertrophy at ENT examination or any history of recurrent acute tonsillitis, and thus their tonsillar core flora could be regarded as normal. The isolation rate of H. influenzae was much lower among sleep apnoea controls (2.7 per cent) than among either the patients with recurrent acute tonsillitis (20.3 per cent) or those with tonsillar hypertrophy (36.7 per cent) (p less than 0.05), as was that of group A streptococci, 5.4 per cent versus 16.9 and 20 per cent, respectively (though the latter differences were not statistically significant). The isolation frequencies of B. catarrhalis, pneumococci, group C and G streptococci did not differ between the three groups. The high tonsillar core recovery rates of H. influenzae and group A streptococci both in patients with recurrent acute tonsillitis and in those with tonsillar hypertrophy, as compared with normal controls, suggests the possible involvement of these bacteria in both conditions.     

An investigation of the significance of Actinomycosis in tonsil disease

OBJECTIVES: The objective of the study was to establish the incidence of Actinomycosis in the tonsils of children undergoing tonsillectomy or adenotonsillectomy, and to evaluate its role in clinical tonsillar disease. METHODS: This was a prospective controlled study done at the Red Cross Children's Hospital in Cape Town, South Africa over an 8-month period and included all children undergoing tonsillectomy or adenotonsillectomy. All resected tonsils were examined for the presence of Actinomycosis and any signs of significant cryptitis or active tonsillitis. A comparison was made in the incidence of Actinomycosis in children with obstructive sleep apnoea, recurrent tonsillitis or obstructive sleep apnoea and recurrent tonsillitis. The data was further analysed to determine the statistical significance of the association between Actinomycosis of the tonsils and age, sex and histopathological and clinical diagnosis. RESULTS: A total of 344 tonsils were analysed on 172 patients. We found 20 patients (11.6%) with Actinomycosis in the tonsils. The mean age of patients with Actinomycosis was 7.25 years and without Actinomycosis was 5.4 years (p=0.002). Most specimens (16) had no evidence of tissue reaction to Actinomyces, and their presence was found to be due to colonisation of the tonsils only. Actinomycosis was present in 11% of patients with obstructive sleep apnoea, 11% of patients with recurrent tonsillitis and in 9% with obstructive sleep apnoea and recurrent tonsillitis. The difference in incidence of Actinomycosis between these three groups (p=0.94), and between the recurrent tonsillitis group alone compared to the obstructive group (p=0.83), was not statistically significant. There was therefore no statistical significance found between Actinomyces and OSA+/- recurrent tonsillitis. CONCLUSIONS: There was no correlation found between the presence of tonsillar Actinomycosis and recurrent tonsillitis and/or obstructive tonsillar hypertrophy. Histopathologic findings showed no evidence of tissue reaction to Actinomyces and its presence was found to be due to colonisation of the tonsils only. The series did however show a statistically significant correlation between Actinomycosis colonisation and age with Actinomycosis being more common in older children, especially those over 5 years of age.     

Spontaneous Tonsillar Hemorrhage and Post-Tonsillectomy Hemorrhage

Spontaneous tonsillar hemorrhage from infectious causes is extremely rare and post-tonsillectomy hemorrhage, although also relatively rare, is an unavoidable complication of the procedure. Hemorrhage in association with tonsillitis or tonsillectomy is potentially dangerous and can be life threatening. We report here the presentation and management of a 42-yr-old man with severe spontaneous hemorrhage from infected tonsils and post-tonsillectomy hemorrhage. We suggest that if attempts to control the bleeding are not successful or if severe spontaneous tonsillar hemorrhage occurs repeatedly or a malignancy is suspected, tonsillectomy and close postoperative follow up is recommended.     

慢性扁桃体炎与扁桃体肥大患者扁桃体中铁和锌含量的研究

目的　通过测定扁桃体组织中铁和锌元素的含量来研究这两种元素在慢性扁桃体炎和扁桃体肥大发病机制中扮演的角色。方法　选取40例在我院行扁桃体切除术的患者,根据病史、临床特征和病理学表现分为扁桃体肥大组和慢性扁桃体炎组。用微波消解-石墨炉原子吸收法测定其扁桃体组织中铁和锌的含量。结果　铁和锌的含量在扁桃体肥大组和慢性扁桃体炎组中均有显著性差异（t 铁=3.89,t 锌=3.63,P 均＜0.001）。扁桃体肥大组中铁和锌的含量均高于慢性扁桃体炎组。结论　扁桃体组织中铁和锌含量的降低会导致扁桃体炎反复发作。     

Flexible endoscopic clip-assisted Zenker's diverticulotomy: the first case series (with videos)

Background: In treating Zenker's diverticulum (ZD), there are potential risks associated with performing flexible endoscopic diverticulotomy without suturing or stapling. We recently introduced flexible endoscopic clip‐assisted diverticulotomy (ECD) in treating ZD by securing the septum prior to dissection. Objective: To evaluate the feasibility and safety of ECD for complete septum dissection. Study Design: Case series at an academic center. Seven consecutive patients (mean age 71 y; range 48–91 y) with symptomatic ZD of various craniocaudal sizes based on radiographic measurements (mean 2.6 cm; range 0.8 cm–4.5 cm) were included. The mean depth of the septum was 1.73 cm (range 0.3 cm–3.1 cm). The mean duration of symptoms was 4.8 years (range 0.5–10 y). Methods: After endoclips were placed on either side of the cricopharyngeal bar, the septum was dissected between these two clips down to the inferior end of the diverticulum with a needle‐knife. Procedures including “one‐step ECD” (n = 1), “stepwise ECD” (n = 3), and “bottom ECD” (n = 2) were performed based on the septum depth of the ZD during endoscopy. ECD was not performed on one patient due to severe mucosal fragility of the esophageal inlet. Iatrogenic blunt dissection of the septum by the endoscopic hood occurred secondary to patient retching during the procedure. Main outcome measurements were symptom resolution and complications. Results: All patients (n = 6) who underwent ECD had complete resolution of esophageal symptoms at a minimum 6‐month follow‐up. There were no procedural complications. The patient who did not undergo ECD developed an esophageal perforation. She was managed conservatively without surgical intervention. On follow‐up, her dysphagia was completely resolved. Conclusions: ECD is feasible, safe, and effective for complete septum dissection. ECD and endoscopic stapler‐assisted diverticulotomy are complimentary rather than competing strategies in approaching ZD. Study limitations include the case series design and limited follow‐up period.     

Comparison of histology between recurrent tonsillitis and tonsillar hypertrophy

To elucidate the aetiology of tonsillar hypertrophy and recurrent tonsillitis, it is important to determine whether a difference exists between these two conditions in microanatomical architecture. The aim of this study was to investigate the difference in follicle size and numbers in tonsils for patients with tonsillar hypertrophy and recurrent tonsillitis using an image analysis method. Our results showed that there was no significant difference in the mean follicle numbers per counting field (40x magnification) between recurrent tonsillitis (4.5 +/- 2.1) and tonsillar hypertrophy (3.8 +/- 0.5). However, the mean follicle area in the tonsillar hypertrophy group (0.23 +/- 0.02 mm2) is significantly (P < 0.01) larger than in the recurrent tonsillitis group (0.15 +/- 0.02 mm2). Our study demonstrates that tonsillar hypertrophy is characterized histologically by an enlargement of follicles compared with chronic tonsillitis, indicating a hyperplastic condition of lymphoid cells in the germinal centres. It may also explain the difference in aetiology and/or immune defence mechanism underlying these two conditions.     

Sarcoidosis of the nose and paranasal sinuses

Sarcoidosis is a chronic systemic disease of unknown etiology characterized by non-caseating granulomatous inflammation of various organs. The records of 2319 patients with the diagnosis of sarcoidosis were reviewed to determine the incidence of nasal involvement. Seventeen patients or approximately 1% of the patients with sarcoidosis had histologically proven nasal mucosa involvement. These patients had symptoms of nasal crusting, congestion, epistaxis, pain, or anosmia. The clinical findings in these patients included friable nasal mucosa, nasal polyps, or a characteristic submucosal nodularity. Most patients also had abnormal sinus roentgenograms with either thickening of the sinus mucosa or opacification of the sinuses. Biopsy of the nasal mucosa shows typical non-caseating granulomas, but care must be exercised to exclude other causes of granulomatous inflammation of the nasal mucosa including tuberculosis, fungal infections, and other idiopathic granulomatous diseases such as Wegener's granulomatosis and Churg-Strauss syndrome. The treatment of nasal sarcoidosis has consisted of systemic steroids and in some cases topical beclomethasone dipropionate.     

Tonsillotomy or tonsillectomy?—a prospective study comparing histological and immunological findings in recurrent tonsillitis and tonsillar hyperplasia

We evaluated the differences in histological and immunological findings in children with recurrent tonsillitis and tonsillar hyperplasia and assessed the risk for relapsing tonsillar hyperplasia or recurrent tonsillitis after tonsillotomy in a prospective clinical study. Sixty-four children with recurrent tonsillitis underwent traditional (total) blunt dissection tonsillectomy between October 2003 and July 2004. Partial tonsillectomy (tonsillotomy) using CO₂-laser technique was performed on 49 children with tonsillar hyperplasia and no history of recurrent tonsillitis between August 2003 and March 2005. The present study compares preoperative serum anti-streptolysin-O antibody and immunoglobulin levels (IgG, IgA and IgM), C-reactive protein levels (CRP) and blood leukocyte counts of the two study groups. Additionally the tonsillar tissue removed by tonsillotomy or tonsillectomy was histologically examined in order to determine the grade of hyperplasia, chronic inflammation and fibrosis. Furthermore, the grade of fresh inflammation within the tonsillar crypts of the specimens was analysed. The parents of 40 patients treated by laser tonsillotomy were surveyed in average 16 months. There was no statistically significant difference in preoperative serum anti-streptolysin-O antibody and immunoglobulin levels, C-reactive protein levels and blood leukocyte counts between the two study groups. All specimens showed the histological picture of hyperplasia. There was no statistically significant difference in the grades of hyperplasia between the two study groups. Signs of fresh but mild inflammation within the tonsillar crypts could be found in over 70% of both study groups. Fibrosis only occurred in children with recurrent tonsillitis (9%). In all specimens signs of chronic inflammation could be detected. The histological examinations of specimens from children with repeated throat infections more frequently showed a moderate chronic inflammation of the tonsillar tissue. Two of forty patients treated by tonsillotomy required a subsequent tonsillectomy due to a recurrence of tonsillar hyperplasia but no recurrent tonsillitis occurred. Tonsillotomy with CO₂-laser technique is an effective surgical procedure with a long-lasting effect in patients with tonsillar hyperplasia. The benefits over conventional tonsillectomy are a lower risk for postoperative haemorrhage, reduced postoperative morbidity and accelerated recovery. Even in children with no history of recurrent tonsillitis signs of chronic inflammation histologically can be found in specimens after tonsillotomy. The occurrence of recurrent tonsillitis after tonsillotomy is rare, however. A low incidence of relapsing tonsillar hyperplasia after tonsillotomy should be expected. Preoperative laboratory investigations show few differences in patients with tonsillar hyperplasia and recurrent tonsillitis. Components of the antimicrobial defense system are also produced by chronically infected tonsils. Therefore tonsillotomy with CO₂-laser could also be an option in some patients with mild symptoms of recurrent tonsillitis.     

Sinonasal disease in patients with sarcoidosis.

Sarcoidosis is a chronic granulomatous disease of unclear etiology with a propensity to involve the lower respiratory tract, but may also involve the upper respiratory tract. Histologically, it is characterized by non-caseating granulomas of various organ systems. Although nasal and sinus involvement is uncommon, patients with sarcoidosis presenting with nasal and sinus complaints may have sinonasal sarcoidosis or simply rhinosinusitis. We reviewed the cases of six patients with pulmonary sarcoidosis who developed chronic sinonasal disease. All six patients had intranasal findings consistent with sinonasal sarcoidosis, but only four had histologic evidence of sinonasal sarcoidosis. These four patients continue to require extensive therapy including topical steroids, systemic steroids, intralesional steroid injections, and nasal irrigations. We conclude that patients with histologically proven sinonasal sarcoidosis present a significant therapeutic challenge because their symptoms and physical findings are often persistent despite aggressive medical and surgical therapy. Their recalcitrant sinonasal disease is thought to result from the destruction of cilia and mucus-producing glands by the granulomatous process.     

Giant cell tumor of the temporal bone – a case report

Background

We aimed to find some new indicators for tonsillectomy (TE) in adults with recurrent tonsillitis (RT) by exploring whether the frequency of tonsillitis episodes and the length of morbidity period are associated with the macroscopic signs of sclerotic process in tonsils and microbiological data assessed by culture, molecular (PCR) and transmission electron microscopy (EM) methods.

Methods

The study involved 62 RT patients admitted for TE (age range 15–35, median 22 years) and 54 healthy volunteers (age range 18–24, median 20 years). The index of tonsillitis (IT) was calculated by multiplying the number of tonsillitis episodes per year by the morbidity period in years. On oropharyngeal examination the presence or absence of three sclerotic signs was evaluated: tonsillar sclerosis, obstruction of tonsillar crypts and scar tissue on the tonsils. The occurrence of Streptococcus pyogenes was assessed by culture and PCR methods in 24 tonsillar core specimens. The samples for EM investigation of crypt epithelium were taken from 10 removed tonsils.

Results

The IT values were in positive correlation with the number of sclerotic signs on oropharyngeal examination (r = 0.325, P = 0.010). Based on the IT values and the presence or absence of tonsillar sclerosis and obstruction of tonsillar crypts the receiver-operating curve (ROC) was constructed. It revealed that an IT score of 36 is an optimal cut-off value for prediction of sclerotic type tonsils. S. pyogenes was never found by culture, but its presence by PCR in nearly one third (29%) of diseased tonsillar tissue specimens was tightly associated with longer morbidity. EM revealed coccoid forms of intracellular bacteria in the crypt epithelium, which was accompanied with the damage of tight junctions between epithelial cells.

Conclusion

The index of tonsillitis ≥36, being a combination between the frequency of tonsillitis and the length of morbidity period, predicts the sclerotic process in recurrently inflamed tonsils. Therefore, the high IT values could serve as an indicator for TE in adults. The correlation between the longer morbidity period and the presence of S. pyogenes by PCR suggests that persistent infection may have a role in maintenance of recurrent inflammation in tonsils.     

睡眠呼吸障碍儿童扁桃体及腺样体组织细菌学分析

目的　探讨睡眠呼吸障碍（sleep disordered breathing,SDB）儿童扁桃体及腺样体组织的细菌学特点。方法　经多导睡眠图监测确诊的163例SDB患儿纳入研究,其中120例同时接受扁桃体及腺样体切除术,4例接受单纯扁桃体切除术,39例接受单纯腺样体切除术,124例接受扁桃体切除术的患儿按照有无扁桃体炎反复发作的病史分为两组,扁桃体炎组71例和无扁桃体炎组53例。术中取部分扁桃体和（或）腺样体组织进行细菌学检查。结果　120例患儿中的114例（95.00%）两个部位分离出的细菌种类相同,120例中有17例（14.17%）两个部位均感染了两种细菌,混合感染的细菌种类均相同。在各个季节两个部位中金黄色葡萄球菌和流感嗜血杆菌的检出率无显著性差异（扁桃体：χ2=8.538,P =0.201;腺样体：χ2=5.427,P =0.490）。有无慢性扁桃体炎病史的扁桃体组织内的各种细菌检出率无显著性差异（χ2=3.028,P =0.387）。结论　同一个SDB患儿的扁桃体和腺样体组织检出的细菌种类几乎相同,有无慢性扁桃体炎病史的扁桃体组织内的不同细菌检出率无显著性差异。     

Bacteriologic comparison of tonsil core in recurrent tonsillitis and tonsillar hypertrophy

OBJECTIVES: Although many bacteriology studies on tonsillar diseases have been completed, all have been confined to children and were characterized by a paucity of cases. The purpose of this study was to analyze the underlying bacterial pathogens in tonsillar disease. METHODS: A retrospective study was performed on 824 patients who underwent elective tonsillectomy with or without adenoidectomy. We analyzed the differences between the bacterial pathogens in recurrent tonsillitis and tonsillar hypertrophy with regard to age, season, and antibiotic sensitivity. RESULTS: Among 824 cases, 966 bacterial strains from the tonsil core were isolated. In recurrent tonsillitis, Staphylococcus aureus was the most common pathogen (30.3%), followed by Haemophilus influenzae (15.5%) and group A beta-hemolytic Streptococcus (Streptococcus pyogenes, 14.4%). In patients over 14 years of age, quite differently from other age groups, Klebsiella pneumoniae was isolated at a significantly higher percentage. In tonsillar hypertrophy, H. influenzae was isolated most commonly (31.4%) regardless of age, followed by S. pyogenes (24.2%), S. aureus (22.9%), and Streptococcus pneumoniae (12.6%). Furthermore, mixed infection was common because of its high resistance to penicillin. In both groups, S. pneumoniae was more common in younger patients, whereas K. pneumoniae was relatively common in adults. We found no differences in the detection rate by season; however, H. influenzae was frequently isolated in the tonsillar hypertrophy group regardless of seasonal variations. We also found no difference in the antibiotic sensitivity between the two groups; however, strains resistant to penicillin were relatively prevalent and showed a high sensitivity to third-generation cephalosporin. CONCLUSIONS: We observed some differences in the types of bacteria in the tonsillar core between the recurrent tonsillitis and tonsillar hypertrophy groups. Our study indicates that essential bacteria have been changing and, thus, we need to change our choice of antibiotics.     

Optimal site for throat culture: tonsillar surface versus posterior pharyngeal wall

To determine the optimal site of throat culture for the detection of potential pathogens by comparing culture results from the tonsillar surface and the posterior pharyngeal wall in children selected for adenotonsillectomy and in children without upper respiratory disease. Cotton culture swabs were taken from the tonsillar surface and the posterior pharyngeal wall of 50 children selected for adenotonsillectomy for symptoms of recurrent tonsillitis and/or adenotonsillar hypertrophy and of 50 children without upper respiratory disease. Potential respiratory pathogens were identified. In the overall group (n = 100), positive culture results were found in 67 posterior pharyngeal wall samples and 47 tonsillar surface samples (P = 0.001). Haemophilus influenzae was the most frequently isolated micro-organism both in the posterior pharyngeal wall and the tonsillar surface samples; 55 and 35%, respectively (P = 0.001). Group A beta-haemolytic streptococci were found in the samples of the posterior pharyngeal wall and the tonsillar surface in 17 and 13%, respectively (P = 0.2). When dealing with patients with sore throat, sampling both tonsillar surfaces is enough for the detection of group A beta-haemolytic streptococci. When detection of other bacteria is also important, such as for research purposes, the posterior pharyngeal wall should be sampled as well.     

Therapeutic effects and prognostic factors of tonsillectomy for IgA nephropathy in long-term follow-up

I investigated several factors that can predict the effect of tonsillectomy for the prevention of renal failure in IgA nephropathy patients. Samples were obtained from 71 patients (35 male and 36 female) who were diagnosed as having IgA nephropathy by renal biopsy and the patients were followed-up for more than 5 years. Mean age at the time of renal biopsy was 28.3 years (8-58 years), and the mean follow-up period was 9 years 9 months (5-19 years). The overall remission rate of IgA nephropathy after tonsillectomy was 28.2%, and the retention rate of renal function was 90.1%, showing a considerably better prognosis than alternative therapies previously reported. Statistical analysis of multiple prognostic factors were examined including the following: sex, age-at-biopsy, renal pathological findings, renal function, serum IgA level, hypertension, past history of tonsillitis, preoperative results of tonsillar provocation test, and the period from diagnosis to tonsillectomy. A statistically significant poorer prognosis after tonsillectomy was observed in the following conditions: < or = 20-years-old when diagnosed, serum creatinine level > or = 1.3 mg/dl, urinary protein > or = 1.0 g/day, serum IgA level > or = 350 mg/dl. No other factors affected the prognosis of renal function statistically, including past history of tonsillitis or positive result of tonsillar provocation test. The present study indicates that there is a beneficial effect of tonsillectomy for mild to moderate IgA nephropathy and that this operation may be indicated for IgA nephropathy as long as the pathological grading is not advanced. On the other hand, tonsillectomy was not effective in cases with poor renal function. Although a past history of tonsillitis and positive results in tonsillar provocation tests have been widely considered as good indicators of tonsillectomy for IgA nephropathy, the present study showed no benefit to consideration of these factors preoperatively.