Tonsillectomy for IgA Nephropathy (Part 2)

An informed patient's perspective

Inflamed kidneys on fire, by Bill Theurer

What’s covered in (Part 2) for subscribers

• Efficacy of Tonsillectomy for IgA Nephropathy in caucasian populations

• Combining Tonsillectomy and Steroid Pulse Therapy

• Mechanisms behind Tonsillectomy's potential effectiveness in IgA Nephropathy

• 4 substantial research papers “against” Tonsillectomy

• Reasons why Tonsillectomy may lack efficacy in different ethnicities

• Desperate need for more research in Western caucasian populations

• Six patient use cases warranting discussion between patients and nephrologists with clinical experience with tonsillectomy with IgAN

• A call to action: mobilizing the community for IgA Nephropathy research

• A link to an extension of the main blog series “for patients” and care givers of those with IgAN.  It addresses important questions regarding end-stage renal failure, dialysis, kidney transplant, the safety and availability of tonsillectomy and guidance for navigating discussions with healthcare providers

• *Podcast* - versions of selected articles - coming soon

This is a “living blog” with iterative updates as we go integrating feedback, new information, additional research, citizen-science project updates, clinical trials, and any necessary corrections.

Efficacy of tonsillectomy for IgA Nephropathy in caucasian populations

While robust data on tonsillectomy for IgA Nephropathy in Caucasian groups is limited in the U.S., Europe, Canada, South America, India, the Middle East, Africa, Australia, international clinicians from Hungary, Egypt, and Romania have contributed valuable case studies, demonstrating a commitment to advancing our understanding in this area.

• 2014 Hungary, Tibor Kovacs looked at 98 patients with Tonsillectomy. The mean renal survival time was significantly longer for both endpoints between those patients who underwent tonsillectomy (Group II) versus patients without tonsillectomy (Group I) (p < 0.001 and p = 0.005). Kovacs concluded; Tonsillectomy may delay the progression of IgA nephropathy mainly in IgA nephropathy patients with macrohaematuria. Prospective investigation of the protective role of tonsillectomy in Caucasian patients is needed.”  (per Moriyama, 68 of those patients underwent tonsillectomy as initial treatment and 30 patients underwent tonsillectomy as pretreatment >3 years before renal biopsy)  (Kovacs, 2014) (here)

• 1996 Hungary, J Barta, 35 kidney biopsy proven IgA nephropathy patients (25 men and 10 women) for an average of 12 years after tonsillectomy, “We found that proteinuria started to decrease significantly already 6 months after tonsillectomy (1.40 +/- 0.27 g/day before tonsillectomy vs 0.92 +/- 0.25 g/day after it, p < 0.05) and was significantly lower under follow-up. The tendency in microhematuria was similar (70.5 +/- 35.0 million RBC/12 hours before and 14.0 +/- 6.5 million RBC/12 hours 6 months after tonsillectomy, p < 0.0001). Furthermore, tonsillectomy stopped gross hematuria appearing in the acute exacerbation of the disease in more than two-thirds of patients. Creatinine clearance did not change in the first 2 years after tonsillectomy, however, from 2.5 years after it is significant slow and continual decrease started (117.0 +/- 9.8 ml/min before and 106.2 +/- 10.8 mil/min 2.5 yrs. after tonsillectomy, p < 0.05). End-stage renal failure was detected only in 4 patients out of 35 after 10 years after tonsillectomy, in our non-tonsillectomised control group in 8 patients out of 40.” (Barta, 1996)

• 2009 Egypt, Mohamed Abd Allah Salama, 15 tonsillectomies after one month from controlling the acute infection resulting in 87% remission for gross hematuria, marked reduction in proteinuria, and serum IgA concentration, urinary abnormalities disappeared and also improvement of renal function, “Conclusion :Tonsillectomy is effective in improving renal function ,urinary symptoms, gross haematoria and decreasing the level of IgA in patients with IgAN if it is done in mild to moderate cases with serum creatinine less than 2mg/d.” (Salama, 2009)

• 2021 Romania, Livia Mirela Popa, single case study, “the decision to perform a tonsillectomy was an effective one”. (Popa, 2021)

• 2010 USA, Benjamin Liess MD, single case study locked behind a paywall, (Liess, 2010)

Combining tonsillectomy and steroid pulse therapy

While solitary tonsillectomy has shown promise (Marumoto above and Nakagawa below), the consensus suggests that combining tonsillectomy with steroid pulse therapy (TSP) and conventional treatments—like anti-inflammatory corticosteroid steroid cycles, ACE inhibitors to control blood pressure, and lifestyle adjustments (low salt and low protein diets, fish oil supplements, regular exercise, cessation of smoking, and avoiding excessive alcohol consumption) —may enhance efficacy. This multimodal approach, integrating tonsillectomy surgery with pharmacological and lifestyle strategies, aligns with a recurring theme in research advocating for TSP as a potentially superior treatment modality.

• 2012, Naoki Nakagawa et al. 40 total (20 with Tonsillectomy alone and 20 with TSP), “TSP group showed a significant decrease in proteinuria and hematuria earlier than T group. The rates of CR were significantly higher in TSP group compared with T group on the final observation period (75% vs. 45%, p<0.05), TSP therapy, an intervention against both pathogenic and immunological mechanisms, can have an improved therapeutic effect on IgAN compared with tonsillectomy alone. Meanwhile, CR was observed, at least, in 45% of tonsillectomy alone patients, indicating that we need a useful tool or biomarker to more precisely predict the therapeutic effect of TSP therapy and tonsillectomy alone.   (Nakagawa, 2012)

• 2019, Norio Kondo et al. 118 tonsillectomies within three months of steroid pulse therapy administered three times, “Our results indicate that TSP is mostly effective in patients with of C-Grade I IgAN and that the C-Grade reflects the clinical indication for TSP.”    (Kondo, 2019)

• 2015, Tetsu Miyamoto et al. 161 patients received TSP and were followed for 4.1 years, “TSP may have a beneficial effect on the clinical course in IgAN patients with mild to moderate glomerular and interstitial lesions, particularly with distinct mesangial cell proliferation.”  (Miyamoto, 2015)

• 2016, Shuntaro Maruyama et al. 38 tonsillectomies conducted before starting steroid pulse therapy, “demonstrated that eGFR, UPCR, and hematuria in patients with relatively early-stage IgAN were dramatically improved after TSP therapy. Moreover, levels of urinary inflammatory (IL-6, MCP-1, ICAM-1, and VCAM-1) and tubular damage (KIM-1 and NAG) markers declined after therapy. Serum IL-6 and ICAM-1 levels also declined significantly, although serum MCP-1 and VCAM-1 levels did not”. (Maruyama, 2016)

Mouse Kidney cells under microscope, CC 2.0

Mechanisms behind tonsillectomy's potential effectiveness in IgA Nephropathy

The separation of tonsillectomy’s unique benefits from its use with other treatments in IgA Nephropathy is challenging. Nonetheless, credible mechanisms have been proposed, such as the role of chronic tonsillar infections, specific oral bacteria, and genetic predisposition may all play a role in over-secretion and production of IgA1/GdIgA1, which could contribute to the disease’s pathology.

• Hitoshi Suzuki 2019, “the multi-hit hypothesis, including production of galactose-deficient IgA1 (Gd-IgA1; Hit 1), IgG or IgA autoantibodies that recognize Gd-IgA1 (Hit 2), and their subsequent immune complexes formation (Hit 3) and glomerular deposition (Hit 4), has been widely supported by many studies.” Mucosal infections, such as tonsillitis and upper respiratory infections, are associated with exacerbation of urinary abnormalities in patients with IgAN.”  “To evaluate therapeutic efficacy, we measured changes in serum levels of Gd-IgA1 before and after tonsillectomy. Cases with IgAN who showed significant decreases in serum Gd-IgA1 levels after tonsillectomy achieved significantly better improvement in hematuria.”  (Suzuki, 2019)

• Moriyama 2020, “The pathogenesis underlying IgAN may arise within the mucosa–bone marrow systems in the nasopharynx-associated lymphoid tissue in Asian patients and the gut-associated lymphoid tissue in European patients (17). Because of the pathogenesis of IgAN, it is important to suppress all of the hits that comprise the multihit hypothesis, from the elevated Gd-IgA1 levels in the lymphoid tissue, which is the first hit, to glomerular inflammation, which is the final hit. Tonsillectomy mainly suppresses increases in Gd-IgA1 levels, which prevents the initiation of IgAN pathogenesis, and steroid pulse therapy suppresses subsequent hits; therefore, together, the synergistic effects of these treatments suppress all hits.  (Moriyama T, 2020)

• Yang 2016, “We consider that after the tonsillar infection/other antigens stimulation in IgAN patients, the over-secretion of IgA1/GdIgA1 from tonsil results in the deposition of IgA1 in glomeruli and renal damage.  This process is dynamic, repeating, and discontinuous. When the same antigen stimulation is attenuated or disappeared, the secretion of IgA1/GdIgA1 declines, vanishes, or even recovers to its normal range. At this time, the deposited IgA1/GdIgA1 in glomeruli diminish or wane. We guess tonsils infections can be regarded as ‘‘trigger point’’. In mucosal immune system, the trigger point is the stimulation of infecting pathogens or any other antigens, the CIC containing Gd-IgA1 is the bullet, and the target is kidney. So, tonsillectomy may in part cut off the ‘‘trigger point’’ of IgAN.” (Yang, 2016)

• Hirano 2019, “The major IgAN manifestations are renal IgA deposition and mesangial proliferation. Impaired immune regulation, characterized by the overproduction of aberrantly glycosylated and polymeric IgA 1, plays an important role in IgAN pathogenesis.  The most evident connection between IgAN and the mucosa–bone marrow pathway is visible hematuria with acute upper respiratory tract infections. Site-specific steroids have been proposed to improve renal prognoses. A novel targeted-release formulation of the corticosteroid budesonide, designed to be delivered to the distal ileum, exhibited an antiproteinuric effect and preserved patients’ renal function in a phase 2b randomized clinical trial. Therefore, site-specific therapeutic strategies targeting the mucosa–bone marrow–kidney axis in patients with IgAN may prove effective against IgAN. (Hirano, 2019)

• Nagasawa 2022, “Oral bacterial species related to dental caries and periodontitis should be candidates because these bacteria are well known to be pathogenic in chronic dental disease. Recently, several reports have indicated that collagen-binding protein (cnm)-(+) Streptococcs mutans is related to the incidence of IgAN and the progression of IgAN. Among periodontal bacteria, Treponema denticola, Porphyromonas gingivalis and Campylobacte rectus were found to be related to the incidence of IgAN. These bacteria can cause IgAN-like histological findings in animal models. Because of epidemiological differences between Asia and Europe, such as the frequency ratio of dental disease and intestinal diseases, the degree of involvement of GALT and NALT in the pathogenesis of IgAN might differ among populations. Tonsillectomy and steroid therapy suppress activated NALT. Oral bacteria such as  mutans related to dental caries and periodontal bacteria are suspected to stimulate NALT activation; nevertheless, the details are not known, but tonsillectomy can eliminate chronic bacterial infection in the tonsils.  (Nagasawa, 2022)

• Krzysztof Kiryluk 2010, provide substantial evidence of familial genetic forms of IgAN. “For instance, Asians (Chinese and Japanese) have a relatively high prevalence of IgAN compared with Caucasians, whereas the disease is infrequently diagnosed in individuals of African ancestry. High frequency of IgAN has also been reported in biopsy series for Native Americans and Oceanians. Extended kindreds with familial IgAN have been reported throughout the world, including the USA, France, Canada, Italy, Australia, and Lebanon. Familial disease accounts for 10-15% of all cases in regions such as northern Italy, France, or eastern Kentucky in the USA, where thorough surveys of relatives have been performed.” “Most importantly, the pathogenesis model depicted in Fig. 3 predicts that interventions that decrease levels of galactose deficient IgA1 or anti-glycan antibodies would reduce formation of immune complexes and positively impact the course of IgAN”.   (Kiryluk, 2010).

• Konishi 2018, looks at 85 tonsillectomies with steroid pulse therapy, “Tonsillar levels of BAF and GdIgA1 correlate with disease activity and treatment responses to tonsillectomy plus steroid therapy, indicating that tonsillar GC B-cell may be involved in the pathogenesis of IgAN via their production of both BAF and GdIgA1.  Tonsillectomy combined with steroid pulse treatment could induce CR in all groups of patients with IgAN.”  (Konishi, 2018)

Tonsils on fire (Tonsillectomy for IgA Nephropathy) by William Theurer

Validity of the tonsillectomy debate for IgA Nephropathy

The vast majority, but not all of the studies I reviewed could be interpreted to be beneficial to be in the T(+) Tonsillectomy group survival and health outcome charts. Debate, is legitimate.  It is how science moves forward. Learnings from a single study could disprove the orthodoxy of the time.

The discussion on tonsillectomy for IgA Nephropathy is multifaceted and scientifically substantial. While many studies suggest benefits, critical evaluation and balanced consideration of all evidence are necessary. The complexity of the data demands ongoing scrutiny to distinguish the specific impacts of tonsillectomy versus combination treatments, especially across different ethnicities. Rigorous methodologies, like randomized control trials, though ideal, face ethical and practical challenges in this context, underlining the need for innovative research approaches to inform treatment strategies.

The ongoing debate around tonsillectomy for IgA Nephropathy (IgAN) highlights the complex interplay between promising studies and the need for critical analysis, especially considering the procedure’s risks and variable outcomes. Distinguishing the benefits of tonsillectomy alone from those of combined therapies is a nuanced challenge, compounded by the potential for research bias and study limitations. Randomized control trials (RCTs) remain the benchmark for robust scientific validation but are not always feasible or ethical, particularly in scenarios requiring placebo controls for serious conditions like IgAN. Consequently, current research often incorporates tonsillectomy as an adjunct to established treatments, aiming to provide the best care while acknowledging the methodological and practical difficulties in executing comprehensive RCTs across diverse populations.

4 substantial research papers “against” tonsillectomy

Let’s review the counterpoint research papers below that are used as justification for NOT performing or presenting Tonsillectomy therapy for Caucasians in the United States and Europe.  I’m happy to append these research workbook rows with additional papers and include/revise blog highlighted examples with items you submit as relevant to enhancing the body of knowledge in this review of tonsillectomy for IgA Nephropathy. Click on the second tab in this workbook link for access to these and/or continue for highlights of each below.

• In 2010, Antonio Piccoli et al. retrospectively looked at 15 cases in Caucasians with a unique perspective of comparing them with 49 control patients with mesangioproliferative glomerulonephritis (MesGN) free of IgA deposits who had tonsillectomy, “The survival to progression to stage 3 was 72% after 20 years in both groups. Tonsillectomy was not associated with a different progression rate of IgAN nor of MesGN after 20 years of follow-up.  Our findings support the notion that it is the steroid component of tonsillectomy + steroids that confers benefit and that tonsillectomy alone is without benefit. At present, there is insufficient data to recommend tonsillectomy for IgAN patients. Those with recurrent bouts of tonsillitis may benefit, but if so, only at some time in the distant future. So, we recommend tonsillectomy following the indications of the otorhinolaryngologist based on the level of airway obstruction and repeated occurrence of acute tonsillitis.  (Piccoli, 2010)  (here)

• In 2015, John Feehally et al., in a widely cited journal article leveraged a study designed to validate a new Oxford classification system for IgAN was able a look at Tonsillectomy and IgAN across Europe. The European validation study of the Oxford classification of IgAN (VALIGA) collected data from 1,147 patients with IgAN over a follow-up of 4.7 years.  “We paired 41 patients with tonsillectomy and 41 without tonsillectomy with similar risk of progression (gender, age, race, mean blood pressure, proteinuria, eGFR at renal biopsy, previous treatments, and Oxford MEST scores). No significant difference was found in the outcome.”  (Feehally, 2015)  (here)

• In 2007, Yu Chen et al. in China performed a 130-month retrospective study. Fifty-four patients underwent tonsillectomy, and 58 patients did not. “Results: Up to 2006, the follow-up period lasted 130 +/- 50.3 months (60-276 months). The clinical remission rate was 46.3% in patients with tonsillectomy and 27.6% in those without tonsillectomy during follow-up. Multivariate analysis demonstrated that tonsillectomy was not an independent impact factor for renal clinical remission (p = 0.386). By Kaplan-Meier analysis, there was no significant difference in renal survival rate between patients with tonsillectomy and those without tonsillectomy (p = 0.059).  (Chen, 2007)  (here)

• In 1999, F M Rasche et al. in Germany, risk factors for progressive IgA nephropathy were equally distributed in 16 patients subjected to tonsillectomy and in 39 patients without tonsillectomy found bivariate Kaplan-Meier analysis the probability of renal survival 10 years after biopsy was 0.37 for the 16 patients with tonsillectomy and 0.63 for the 39 patients without tonsillectomy (log-rank test p = 0.49, not significant), concluded “tonsillectomy does not reduce the risk of developing renal failure or prevent a progressive course of IgA nephropathy.”  (Rasche, 1999)  (here)

cGene expression matrix, Dvir Netanely, CC BY-SA 3.0

Why tonsillectomy may lack efficacy in different ethnicities

I want to acknowledge and commend the diligent efforts of researchers who critically assess the findings on tonsillectomy from Japan and China. Such rigorous scrutiny is vital for ensuring that the scientific method yields the most accurate and reliable results over time.  Systematically addressing the issue from all angles will eventually lead to optimal resolution, with your help and participation ideally in the nearer future.

• 2014 Zand et al. reviews Kawamura’s 2014 RCT trial and comments, “activation of intestinal lymphoid tissue, rather than tonsillar, may also play a role in the pathogenesis of IgAN and tonsils represent only a small part of the gut-associated lymphoid tissue (GALT) mass. Second, in patients with IgAN, polymeric IgA-secreting plasma cells are increased systemically in particular in the bone marrows. As such, it should not be surprising that tonsillectomy alone does not result in long-term depression in secretory IgA. In fact, data from the VALIGA study showed that even though the serum degalactosylated IgA1 levels were lower in tonsillectomized patients compared with non-tonsillectomized individuals, the levels were still significantly higher than controls. Finally, increased production of galactose-deficient IgA1 is only one step in the development of IgAN and other factors including production of IgG-anti-IgA antibodies and activation of complement pathway in the renal mesangium play a major role.  (Zand, 2014)

• 2022 Nagasawa, the composition of gut microbiota may be different with IgAN. Gut bacteria alone may be able to modulate mucosal IgA production, and O-galactosylation of IgA1 in GALT through activation of lymphoid TLRs.  Food antigens, such as gluten, might have pathogenicity of IgAN. Observation that a gluten-free diet reduces serum levels of IgA, including circulating immune complex, and IgA reactive to dietary antigens, suggests that it may correct immunological abnormalities in certain IgA nephropathy patients. “Based on these findings a gut–renal connection in IgAN had been proposed.”  (Nagasawa, 2022)

• 2018 Neugut, “Genetic factors that are unique to an Asian population may influence response to the surgical intervention.”  (Howard Trachtman, 2019) “Population-based genome-wide association studies (GWAS) have discovered nearly 20 IgAN risk loci, providing novel insights into disease epidemiology and molecular mechanisms, shifting old paradigms of the disease pathogenesis.”  (Neugut, 2018)

Desperate Need for More Research in Western Caucasian Populations

The current understanding of tonsillectomy’s efficacy in treating IgA Nephropathy is incomplete and varies by ethnicity. This gap suggests a need for more inclusive research, particularly for non-Asian populations and Asians in living in Western populations. A question remains whether the lack of evidence for certain demographics is being misinterpreted as a lack of efficacy, potentially impeding access to this treatment. It’s clear that further investigation is needed to offer equitable healthcare options.

Western Caucasian populations grappling with IgA Nephropathy face an urgent need for effective treatments, a need that cannot be postponed for additional decades.

The disparity in the volume of research between Western countries and Asia suggests that solutions could potentially have been found earlier in the West.

As its acceptance grows in Asia, we need to address the reluctance to advance tonsillectomy as a treatment option in these regions. This requires a collective effort to bridge the gap in understanding and application.

• Dr Howard Trachtman (United States) “The American Academy of Pediatrics guidelines recommend that obstructive sleep apnea syndrome with adenoidal hypertrophy, malignancy, and recurrent hemorrhage are absolute indications, while recurrent tonsillitis or recurrent peritonsillar abscess are relative indications. There is no mention of kidney disease. Should IgA nephropathy be added to this list of relative indications? Tonsillectomy is performed infrequently in adults and there is little literature on its proper use. Should the Boards of Internal Medicine and Otorhinolaryngology weigh in on this topic? The study by Hirano (Hirano, 2019) offers important new evidence to include in these discussions.”  (Howard Trachtman, 2019)

• Dr Adam Mariotti (United States) “In conclusion, IgAN is a disease with a varied clinical course and one in which no standard therapy has been established. Previous studies examining the role of tonsillectomy in this disease have shown favorable results. Our series of 6 patients showed excellent resolution of symptoms. Timely referral of children with appropriate indications for tonsillectomy is critical. Randomized controlled studies are needed to better establish the efficacy of tonsillectomy and to better define its use, but the practicing otolaryngologist should be aware of this indication for tonsillectomy.” (Adam J. Mariotti, 2009)

Six patient use cases warranting discussion between patients and nephrologists with clinical experience with tonsillectomy with IgAN:

• A subject of Asian descent in a predominantly Caucasian population where the procedure is not normally performed.

• A patient subject with diagnostic indications for Tonsillectomy that happens to have IgAN

• Newly diagnosed biopsy confirmed patients of all ethnicities

• Existing patients with long-term IgAN not in remission

• Patients on dialysis and approaching ESRF

• Patients with recurrent IgAN after kidney transplant

Seeking global insights on Tonsillectomy for IgA Nephropathy from nephrologists across cultures

Here I am reaching out to nephrologists who’ve practiced in Asia and now serve Caucasian populations to share insights on tonsillectomy outcomes for IgA Nephropathy. Western cases of tonsillectomy performed for reasons unrelated to IgA Nephropathy, may also have the potential to contribute to our understanding of its impacts. By pooling global clinical experiences and exploring retrospective patient data, we can foster a more informed dialogue and propel research efforts forward, uniting healthcare professionals, researchers, and stakeholders in a collective endeavor to advance patient care.

If you are a relocated nephrologist with clinical experience across cultures or otherwise have clinical experience with Tonsillectomy and IgAN in non-Asian and Asian populations please kindly share comments at the end of the blog and join the long-form community forum topic dedicated to this.

A call to action: mobilizing the community for IgA Nephropathy research

Engaging the broader community can accelerate research into IgA Nephropathy, particularly within non-Asian populations in the US and Europe. By leveraging data from healthcare organizations, we can drive citizen-science initiatives, gather global patient experiences, and incentivize researchers at the start of their careers. Collaborative efforts to analyze existing medical records and encourage retrospective studies can lay the foundation for more extensive, controlled research, all while ensuring that the quest for knowledge is a shared mission supported by crowd-funding and grants.

If this blog gains enough worldwide momentum a citizen-science project roadmap might look something like this.

Join us in the Substack discussion threads below. At crowd-scale we can accelerate research toward solutions.

For patients and care givers continue to (Part 3) -A patient-centered Q&A guide

It addresses important questions regarding end-stage renal failure, dialysis, kidney transplant, the safety and availability of tonsillectomy and guidance for navigating discussions with healthcare providers

After finishing Part-2 please join us in the Substack discussion threads below. At crowd-scale we can accelerate research toward solutions.

For the most engaged on the topic I have created a community forum where we can gather, share, learn and organize crowd-scale projects that advance patient outcomes.

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Bibliography

• Adam J. Mariotti, M. (2009). The role of tonsillectomy in pediatric IgA nephropathy. Retrieved from JAMA Network.

• Barta, J. (1996). Does tonsillectomy cause any change in long-term course of IgA nephropathy? Retrieved from Europe PMC.

• Baugh, R. F. (2011). Clinical practice guideline: tonsillectomy in children. Retrieved from PubMed.

• Bohr C, S. C. (2023). Tonsillectomy and Adenoidectomy. Retrieved from NCBI.

• Chen MM, R. S. (2014). Safety of Adult Tonsillectomy: A Population-Level Analysis of 5968 Patients. Retrieved from JAMA Network.

• Chen, Y. (2007). Long-Term Efficacy of Tonsillectomy in Chinese Patients with IgA Nephropathy. Retrieved from PubMed.

• Chou, Y.-H. (2021). Aging and Renal Disease: Old Questions for New Challenges. Retrieved from NCBI.

• Feehally, J. (2015). the European Validation of the Oxford Classification of IgAN (VALIGA) study. Retrieved from Karger.

• Foundation, I. N. (n.d.). What is IgA Nephropathy and how does it affect your kidneys? Retrieved from IgAN Foundation.

• Foundation, N. K. (n.d.). The Kidney Transplant Waiting List – what you need to know. Retrieved from National Kidney Foundation.

• Francesco Paolo Schena, I. N. (n.d.). Epidemiology of IgA Nephropathy: A Global Perspective. Retrieved from ScienceDirect.

• Garreta, E. (2021). Human induced pluripotent stem cell-derived kidney organoids toward clinical implementations. Retrieved from ScienceDirect.

• Glassock, R. J. (n.d.). Mortality Risk in IgA Nephropathy, Journal of the American Society of Nephrology. Retrieved from JASN.

• Griffith, B. P. (2022). Genetically Modified Porcine-to-Human Cardiac Xenotransplantation. Retrieved from NEJM.

• Hirano, K. (2019). Association Between Tonsillectomy and Outcomes in Patients With Immunoglobulin A Nephropathy. Retrieved from NCBI.

• Howard Trachtman, M. (2019). Tonsillectomy for the Management of Immunoglobulin A Nephropathy. Retrieved from JAMA Network.

• Jarrick S, L. S. (n.d.). Mortality in IgA nephropathy—a nationwide population-based cohort study. Retrieved from NCBI.

• Kiryluk, K. (2010). Genetic studies of IgA nephropathy: past, present, and future. Retrieved from NCBI.

• Kondo, N. (2019). Tonsillectomy plus steroid pulse therapy is the most effective treatment in adult patients with C-Grade I IgA nephropathy, and the weight of the extracted palatine tonsils and Yamamoto scale have no significant correlation with the effects of this treatment. Retrieved from ScienceDirect.

• Konishi, M. (2018). TONSILLAR EXPRESSION OF B-CELL ACTIVATING FACTORS AND GLUCOSE DEFICIENT IGA1 CORRELATES WITH DISEASE ACTIVITY OF IGA NEPHROPATHY. Retrieved from NDT.

• Kovacs, T. (2014). Effect of tonsillectomy and its timing on renal outcomes in Caucasian IgA nephropathy patients. Retrieved from PubMed.

• Lewis, T. (2023). How New Advances in Organ Transplants Are Saving Lives. Retrieved from Scientific American.

• Li, Y. (2022). Efficacy and indications of tonsillectomy in patients with IgA nephropathy: a retrospective study. Retrieved from PeerJ.

• Liess, B. (2010). Tonsillectomy for the treatment of tonsillitis-induced immunoglobulin A nephropathy. Retrieved from ScienceDirect.

• Liu, L.-l. (2015). Original Investigation Tonsillectomy for IgA Nephropathy: A Meta-analysis. Retrieved from PubMed.

• Maharjan, S. (2022). Strategies towards kidney tissue biofabrication. Retrieved from ScienceDirect.

• Marumoto, H. (2020). Tonsillectomy Monotherapy for IgA Nephropathy: A Case Series. Retrieved from ScienceDirect.

• Maruyama, S. (2016). Beneficial effects of tonsillectomy plus steroid pulse therapy on inflammatory and tubular markers in patients with IgA nephropathy. Retrieved from ScienceDirect.

• Matsuzaki, K. (2013). Nationwide survey on current treatments for IgA nephropathy in Japan. Retrieved from NCBI.

• Miyamoto, T. (2015). Impact of tonsillectomy combined with steroid pulse therapy on immunoglobulin A nephropathy depending on histological classification: a multicenter study. Retrieved from SpringerLink.

• Montgomery, R. A. (2022). Results of Two Cases of Pig-to-Human Kidney Xenotransplantation. Retrieved from NEJM.

• Moriyama T, K. K. (2020). Long-Term Beneficial Effects of Tonsillectomy on Patients with Immunoglobulin A Nephropathy. Retrieved from NCBI.

• Nagasawa, Y. (2022). Title IgA Nephropathy and Oral Bacterial Species Related to Dental Caries and Periodontitis. Retrieved from NCBI.

• Nakagawa, N. (2012). Comparison of the Efficacy of Tonsillectomy with and without Steroid-pulse Therapy in IgA Nephropathy Patients. Retrieved from Internal Medicine.

• Nephrol., C. J. (2021). Recurrence of IgA Nephropathy after Kidney Transplantation in Adults. Retrieved from NCBI.

• Neugut, Y. D. (2018). Genetic Determinants of IgA Nephropathy: Western Perspective. Retrieved from PubMed.

• Piccoli, A. (2010). Influence of tonsillectomy on the progression of mesangioproliferative glomerulonephritis. Retrieved from NDT.

• Ponticelli, C. (2012). Tonsillectomy and IgA nephritis. Retrieved from NDT.

• Popa, L. M. (2021). Tonsillectomy in IgA Nephropathy – Clinical Case. Retrieved from Sciendo.

• Rasche, F. M. (1999). Tonsillectomy does not prevent a progressive course in IgA nephropathy. Retrieved from Europe PMC.

• Richard Schmidt, M. (2007). Complications of Tonsillectomy A Comparison of Techniques. Retrieved from JAMA Network.

• Rychlik I, A. K. (1999). Clinical features and natural history of IgA nephropathy. Retrieved from PubMed.

• Salama, M. A. (2009). Role of tonsillectomy in the management of IgA nephropathy. Retrieved from Egyptian Journal of Hospital Medicine.

• Suzuki, H. (2019). Biomarkers for IgA nephropathy on the basis of multi-hit pathogenesis. Retrieved from NCBI.

• Ushigome, H. (2009). Efficacy of tonsillectomy for patients with recurrence of IgA nephropathy after kidney transplantation. Retrieved from Wiley Online Library.

• Yang, D. (2016). The efficacy of tonsillectomy on clinical remission and relapse in patients with IgA nephropathy: a randomized controlled trial. Retrieved from Taylor & Francis Online.

• Zand, L. (2014). Does tonsillectomy have a role in the treatment of patients with immunoglobulin A nephropathy? Retrieved from NDT.

• Zhu, L. (2018). Clinical efficacy of tonsillectomy in RENAL TRANSPLANT patients with recurrent IgA nephropathy. Retrieved from PubMed.