Affiliation:
1. The Jikei University School of Medicine
Abstract
Abstract
There is insufficient evidence to confirm the involvement of tonsillar immune disorders in the pathogenesis of IgA nephropathy (IgAN). This cross-sectional study investigated the association between histological changes in the palatine tonsil, its clinical presentation, and renal histopathological findings in IgAN. Eighty-seven patients with IgAN who underwent tonsillectomy within one year of undergoing renal biopsy were compared with 27 age-matched patients with recurrent tonsillitis (RT). The mean lymphoid follicle and germinal center sizes in patients with IgAN were significantly smaller than in those with RT (P < 0.001). The relative areas of lymphoid follicles (%LFA) and germinal centers in the total tonsillar tissue were smaller in IgAN than in RT (P < 0.001). The mean interfollicular area was larger in patients with IgAN than those with RT. Crypt epithelia in IgAN showed more expanded non-reticular areas lacking lymphoepithelial symbiosis than those observed in RT (P = 0.003). Lower %LFA was associated with higher urinary protein excretion (P = 0.01) and a longer period from the onset of urinary abnormalities to renal biopsy. A lower %LFA was associated with S and C lesions in the Oxford classification. The frequency of glomeruli with sclerotic lesions showed a close inverse correlation with %LFA (ρ = -0.46, P < 0.001). Reduced size of lymphoid follicles and germinal centers, enlarged interfollicular areas, and expanded non-reticular crypt epithelia in the palatine tonsils were prominent IgAN features. Reduced %LFA showed a significant correlation with IgAN renal histopathological severity, supporting the concept of accelerated involution of secondary lymphoid follicles during IgAN progression.
Publisher
Research Square Platform LLC