Studies On The Changes Of Serum Level Of IgA1 And Urinary Findings Before And After Tonsillectomy And The Relationship Between The Two In IgA Nephropathy Patient

Objectives1. Serum level of IgA and IgA1 were measured in healthy controls ,as well as in chronic tonsilitis patients with IgA nephropathy and without nephritis.2.Patients of IgAN and non-nephritis were subjected to tonsillectomy as tonsils stimulation. (1) A serial quantitative analysis of proteinuria and hematuria was evaluated at four different time points(before, the first day ,the third day and the fifth day after the tonsillectomy). The erythrocyte count in the sediment and the level of urinary protein were studied to define the deterioration of urinary findings ;(2) Previous episodes of gross hematuria following upper respiratory tract infections were reviewed by asking to the patients.(3) To study the serum level of IgA, IgA1 and C3 at five different time points (before, zero hour,the first day ,the third day and the fifth day after the tonsillectomy)in chronic tonsilitis patients with IgA nephropathy and non-nephritis separately.(4)Researching the correlation between erythrocyte count in the sediment and serum level of IgA, IgA1 and C3 to clarify the involvement of tonsils in the pathogenesis of IgA nephropathy.MethodsThe study included 17 chronic tonsilitis patients with IgA nephropathy (group of IgAN) ,17 chronic tonsilitis patients without nephritis(group of non-nephritis for short) and 17 healthy controls(group of controls) whose age, height, weight were matched with that of group of IgAN. All patients of group of IgAN and non-nephritis were subjected to tosillectomy in the condition of general anesthesia. The first urina sanguinis were collected before, the first day ,the third day and the fifth day after the tonsillectomy. The erythrocyte count in the sediment and the level of urinary protein were analyzed to define the deterioration of urinary findings. When erythrocyte count increased more than 41667/ml(equal to about 10/HP) or urinary protein increased more than a class,it was regarded as a deleterious change. Previous episodes of gross hematuria following upper respiratory tract infections were reviewed by asking to the patients. At the same time, blood was collected before, zero hour,the first day ,the third day and the fifth day after the tonsillectomy. Serum level of IgA and C3 were measured by immunoturbidimetry, while serum IgA1 was measured by sandwich enzyme-linked immunosorbent assay(ELISA).Results1 .Thirteen of 17 patients with IgAN(76.47 %) showed a deterioration of urinary findings after tonsillectomy compared with two of 17 patients without nephritis( 11.76%). The deterioration was significantly more frequent in group of IgAN than in group of non-nephritis(P < 0.01).2.Previous episodes of gross hematuria following upper respiratory tract infections existed in 13 of 17 patients(group A1) who showed a deterioration of urinary findings after tonsillectomy (69.23%) as against in zero of 4 (group A2) without the deterioration (0%). They were significantly more frequent in group A1 than group A2(P < 0.05).3.Both the level of serum IgA and IgA1 were significantly higher in group of IgAN than in group of non-nephritis or group of controls respectively(P < 0.05).But there is no significant difference between group of non-nephritis and group of controls(P>0.05).4.In group of IgAN, the level of serum IgA and IgA1 of the third day after tonsillectomy were significantly higher than before(P < 0.05),but no significants were showed between the other times after tosillectomy and before(P > 0.05).After tonsillectomy ,the level of serum C3 did not change significantly in group of IgAN(P > 0.05).5.After tonsillectomy , the level of serum IgA and IgA1 did not change significantly in group of non-nephritis (P > 0.05).6.The serum level of IgA and IgA1 correlated significantly with the erythrocyte count in the urinary sediment (P < 0.01, r_s =0.365, r_s =0.351 respectively).No correlation was found between erythrocyte count in the urinary sediment and the level of serum C3(P > 0.05).Conclutions1.Patients of IgAN showed a significant deterioration of urinary findings after tonsillectomy. This suggested that some local lesion of the tonsils such as chronic tonsillitis may be involved in the pathogenesis of IgA nephropathy.2. Deterioration of urinary findings and previous episodes of gross hematuria following upper respiratory tract infections correlated significantly in IgAN patients, tonsil stimulation through tonsillectomy created a condition similar to that induced by an upper respiratory tract infection.3.Both the level of serum IgA and IgA1 were significantly higher in group of IgAN than in group of non-nephritis or group of controls respectively. After tonsillectomy which stimulating tonsils, the level of serum IgA and IgA1 of the third day after tonsillectomy were significantly higher, the erythrocyte count in the sediment and the level of urinary protein were significantly more ,which suggested a deterioration of urinary findings. Moreover, serum IgA and IgA1 level correlated significantly with the erythrocyte count in the urinary sediment. All of these provided more direct evidence for the close relationship between tonsils and IgAN .These may be involved in the pathogenesis of IgA nephropathy.