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6 6) Suzuki S, Nakatomi Y, Sato H et al: Haemophilus bearing lymphocytes and increased polymeric IgA synthesis. Clin Exp Immunol 57: , ) Berger J, Hinglais N: Les depots intercapillaires d'iga-igg. J Urol Nephrol 74: , ) Berger J: IgA glomerular deposits in renal disease. Transplant Proc 1: , parainfluenzae antigen and antibody in renal biopsy samples and serum of patients with IgA nephropa thy. Lancet 343: 12-16, ) Egido J, Blasco R, Lozano L et al: Immunological abnormalities in the tonsils of patients with IgA nephropathy: inversion in the ratio of IgA: IgG 9) Tamura S, Masuda Y, Inokuchi I et al: Effect of and indication for tonsillectomy in IgA nephropathy. Acta Otolaryngol 508 (Suppl): 23-28, ) Baba Y, Akagi H, Fukushima K et al: Quantitative analysis of interleukin 6 (IL-6) in patients with IgA nephropathy after tonsillectomy. Auris Nasus Larynx 26: , ) Matsuda M, Shikata K, Wada J et al: Increased uri nary excretion of macrophage-colony-stimulating factor (M-CSF) in patients with IgA nephropathy: tonsil stimulation enhances urinary M-CSF excre tion. Nephron 81: , 1999.

7 15) Akagi H, Fukushima K, Kosaka M et al: A 10-year retrospective case-control study for IgA nephropathy after tonsillectomy. ICS 1257: , ) Hotta 0, Miyazaki M, Furuta T et al: Tonsillectomy and steroid pulse therapy significantly impact on clinical remission in patients with IgA nephropathy. Am J Kidney Dis 38: , ) Xie Y, Nishi S, Ueno M et al: The efficacy of tonsil lectomy on long-term renal survival in patients with IgA nephropathy. Kidney Int 63: , ) Xie Y, Chen X, Nishi S et al: Relationship between tonsils and IgA nephropathy as well as indications of tonsillectomy. Kidney Int 65: , ) Tomioka S, Miyoshi K, Tabata K et al: Clinical study of chronic tonsillitis with IgA nephropathy treated by tonsillectomy. Acta Otolaryngol 523 (Suppl): , ) Sato M, Hotta O, Tomioka S et al: Cohort study of advanced IgA nephropathy: efficacy and limitations of corticosteroids with tonsillectomy. Nephron Clin Pract 93: , 2003.

8 Indication criteria for tonsillectomy in patients with IgA nephropathy Hirofumi Akagi 1), Kazunori Nishizaki 2) 1) Department of Otolaryngology, Incorporated Administrative Agency National Hospital Organization Minami-Okayama Medical Center 2) Department of Otolaryngology-Head and Neck Surgery, Okayama University Graduate School of Medicine and Dentistry We investigated the indications for tonsillectomy in patients with IgA nephropathy based on the longterm results of treatment and the prognostic factors that can predict the effect of tonsillectomy for the pre vention of renal failure. Subsequently, indication criteria for tonsillectomy in patients with IgA nephropathy were proposed based on the contents we investigated. They are as follows. 1) IgA nephropathy is definitively diagnosed by evaluating the renal glomeruli at renal biopsy. 2) Tonsillectomy is indicated for patients with Grade I to III renal pathology and with a serum crea tinine level of 2.0 mg/dl or less at renal biopsy. However, even among patients with Grade IV or with a serum creatinine level more than 2.0 mg/dl at renal biopsy, surgery should be considered in the absence of contraindications for tonsillectomy, such as renal hypofunction, when they want to undergo surgery and informed consent is obtained. 3 ) Medical history includes deterioration of urine findings at tonsillitis or acute upper respiratory inflammation. 4) As local findings of the palatine tonsil, buried tonsils and attachment of pus plugs to the tonsillar crypt are observed. 5) Positive findings, especially positive urine findings (hematuria), are detected on tonsillar provo cation test. Items 1) and 2) are essential. evidence. Items 3) to 5) are reference items, as no previous study meets the Key words: indication for tonsillectomy, IgA nephropathy, renal pathology, serum creatinine, tonsillar provocation test

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