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Title: [Therapeutic effect of tonsillectomy on IgA nephropathy after kidney transplantation].
Author: Deng RH, Li J, Zhang HX, Li J, Fu Q, Huang G, Liu LS, Fei JG, Chen WF, Yang SC, Wang CX, Deng SX.
Journal: Zhonghua Yi Xue Za Zhi; 2020 Aug 11; 100(30):2378-2382. PubMed ID: 32791815.
Abstract:
Objective: To observe the clinical effect of tonsillectomy on IgA nephropathy (IgAN) after renal transplantation. Methods: From March 2011 to July 2018, 201 kidney transplantation recipients who were diagnosed of IgAN by transplant renal biopsy in the Department of Organ Transplantation of the First Affiliated Hospital of Sun Yat-sen University were retrospectively reviewed, of which 18 patients underwent tonsillectomy after renal biopsy. The clinical data of the 18 patients were collected, patient and kidney survival time and function of the transplanted kidney were analyzed. Results: Of the 18 recipients, 13 were male and 5 were female, with an average age of (36.0±10.9) years. All 18 patients survived during follow-up. Two patients returned to dialysis treatment 10 months and 14 months after tonsillectomy, respectively. The creatinine was 94 (78, 133) μmol/L, 95 (74, 139) μmol/L, 106 (87, 158) μmol/L and 95(81, 147) μmol/L before tonsillectomy, 3 months, 1 year and 2 years after tonsillectomy, respectively (P=0.206). Urinary protein quantification was 0.31 (0.16, 1.38) g/24 h, 0.34 (0.10, 1.42) g/24 h, 0.33 (0.11, 0.56) g/24 h and 0.25 (0.10, 0.50) g/24 h at the same time points, respectively (P=0.104). The two patients who returned to dialysis were diagnosed of IgAN by transplant renal biopsy because of elevated creatinine, proteinuria and hematuria, 9 years and 4 years after kidney transplant respectively. Renal biopsy suggested that glomerular and segmental sclerosis were 7/24, 5/24 and 1/6, 2/6, respectively. Additionally, interstitial fibrosis and tubular atrophy (IF/TA) were both occupied 30% in the biopsies, and tonsillectomy was performed 461 days and 1 077 days after diagnosis of IgAN, respectively. Conclusions: Tonsillectomy can maintain the stability of renal function and prevent the aggravation of proteinuria in IgAN patients after renal transplantation. However, if pathology suggests obvious glomerulosclerosis or IF/TA, tonsillectomy may not be effective. 目的： 观察扁桃体切除术对治疗肾移植术后IgA肾病（IgAN）的临床疗效。 方法： 2011年3月至2018年7月，在中山大学附属第一医院器官移植科行移植肾穿刺活检病理诊断为IgAN的患者201例，其中18例患者进行了扁桃体切除术。收集该18例患者的临床资料，分析患者及移植肾存活时间及移植肾功能情况。 结果： 18例受者中男13例，女5例，年龄（36.0±10.9）岁。随访期间，所有患者均存活。2例患者分别在扁桃体切除术后10个月和14个月移植肾失功后恢复透析治疗。扁桃体切除术前患者血肌酐94（78，133）μmol/L，扁桃体切除后3个月、1年和2年血肌酐分别为95（74，139）μmol/L，106（87，158）μmol/L和95（81，147）μmol/L（P=0.206）。扁桃体切除术前患者24 h尿蛋白定量为0.31（0.16，1.38）g，扁桃体切除术后3个月、1年和2年患者的24 h尿蛋白定量分别为0.34（0.10，1.42）g、0.33（0.11，0.56）g和0.25（0.10，0.50）g（P=0.104）。移植肾失功的2例患者，分别是肾移植术后9年和4年因为血肌酐升高、蛋白尿和血尿行移植肾穿刺活检确诊IgAN，病理提示球性硬化和节段硬化分别为7/24、5/24和1/6、2/6，间质纤维化与肾小管萎缩（IF/TA）均为30%，该2例患者分别是在确诊IgAN后461 d和1 077 d后才行扁桃体切除术。 结论： 肾移植术后IgAN行扁桃体切除术能帮助维持肾功能稳定，防止蛋白尿加重。病理提示肾小球硬化或IF/TA较明显的患者，扁桃体切除术效果不佳。.

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