Effect Of Tonsillectomy On Matrix Metalloproteinase-2 In Patients With IgA Nephropathy

Background: IgA nephropathy (IgAN) is the most common kind ofprimary renal glomerulus disease in the whole world. IgAN was originallyregarded as a benign condition, but we find now it was followed the trail formore than 20 years , about 20-50% of the patients developed to end stage renalfailure . To those IgAN with hematuria and/or mild or moderate proteinuria,there is not an established therapy up until now. The indication , validity andpossible mechanism of the tonsillectomy in IgAN are still not clear at present.Objective: The study of the changes of urinary abnormalities and matrixmetalloproteinase-2 (MMP-2) in serum for IgAN after tonsillectomy is doneto investigate the effect on IgAN of tonsil and possible mechanism, guide theclinical treatment , delay the progress of the pathogenetic condition.Methods: The subjects were 33 patients,with a definite diagnosis of IgANbased on renal biopsy from 2003.12 to 2005.12 in our hospital ,excludingsecondary IgAN.They were influenced by tonsillar focal infections and dividedinto two groups with and without tonsillectomy. The therapy includingangiotensin change enzyme inhibitor (ACEI) or angiotensin II receptor blocker(ARB) was administered to the patients of both groups if 24-hour urine proteinamount was more than 0.5g. Detect and compare the clinic and laboratoryindexes of two groups, including age while renal biopsy being took, sex, courseof disease, follow-up period, blood pressure, serum creatinine, 24-hour urineprotein amount. SDS-PAGE enzymography was carried out detecting andcompare the level of pro-MMP-2 and MMP-2 activity in serum among normalcontrol group, operation group and non-operation control group. Multipleinterclass materials data comparision is based on mean square analysis andLSD-t to examine. If P<0.05, it is significant on statistics .Results: The clinical manifestations of the two groups with and withoutTonsillectomy involved mainly hematuria and/or mild or moderate proteinuria.Kidney pathology Lee classification takes â… ,â…¡and â…¢ grade as the core ingrades. There isn't obvious difference on the clinical and laboratory indexes ofthe patients such as the age while renal biopsy being took, sex, course ofdisease, blood pressure, serum creatinine, 24-hour urine protein amount inboth group(sP>0.05). The urinary abnormalities of the patients in groups bothwere improved after therapy, especially tonsillectomy group. Compared withnomal control group, IgAN had a higher level of MMP-2 activity in serum(P<0.01).Both the tonsillectomy and non-operation control groups had a lowerlevel of MMP-2 activity after treatment, especially tonsillectomy group,butthey still higher than nomal(P<0.01). There isn't obvious difference on thelevel of pro-MMP-2 in serum among all groups. The relation between theextent of damage of kidney pathology and urinary abnormalities is not found.The same to MMP-2.Discussion: The result shows tonsillectomy combined with intensivetherapy can receive a favorable remission of urinary abnormalitiesis for IgANwith mild or moderate renal pathological damage. Clinical manifestations ofthese patients take hematuria as the core, or with mild or moderate proteinuria(24-hour urine protein amount is less than 1.5g). Kidney pathology Leeclassification of these patients takes â… ,â…¡and â…¢ grade as the core in grades.The patients with serious damage of kidney pathology such as globalglomerular sclerosis, small glomerular crescents and interstitial fibrosis didnot performed tonsillectomy even if they had tonsillar focal infections.Because the patients in the study all had a mild or moderate renal damage andthey had performed intensive therapy during the follow-up period, we do notfound the patients who had hypertension or renal failure. At the same time itmaybe unreasonable to excluding the patients with a large number ofproteinuria because they were not fit for tonsillectomy. The relation betweenthe extent of kidney damage and urinary abnormalities is not found. MMP-2can not only participate in the degradation of ECM but also lead mesangialcells into inflammation subsequently a increase in mesangial cells andmatrixes ,eventually glomerulosclerosis. In the study we found compared withnomal control group, IgAN had a higher level of MMP-2 activity in serum andthere was a decline after treatment especially in tonsillectomy group. Theexpression and activation of MMP-2 are formated by the excreting, activationand TIMP. There wasn't an obvious difference on the level of pro-MMP-2 inserum among all groups, so we speculate that therapy including tonsillectomymay lead to a decline of MMP-2 in the sector of activation and TIMP.Tonsillectomy maybe play a role in improving the renal local immuneresponse, regulating the level of MMPs, making a balance between ECMsynthesis and degradation , and then influence the prognosis of IgAN. Thelevel of pro-MMP-2 and MMP-2 activity in IgAN serum detecting bySDS-PAGE enzymography can predict the prognosis and treatment for IgAN.The method with a high positive rate is simple and convenient, which canapply to clinic extensively .Conclusion: 1.Tonsillectomy can improve urinary abnormalities andIgAN with hematuria and/or mild or moderate proteinuria who has mild ormoderate renal pathology and an influenced by tonsillar local infectionsshould be given tonsillectomy;2.Tonsillectomy combined with routinetherapy can lead to a lower level of the expression of MMP-2 when comparedwith routine therapy, which maybe one of the mechanisms for tonsilinfluencing IgAN;3. The level of MMP-2 activity in IgAN is higher thannomal and lower after treatment, so we can predict the prognosis andtreatment for IgAN by detecting MMP-2 in serum.