Tonsillectomy for the Management of Immunoglobulin A Nephropathy | Allergy and Clinical Immunology | JAMA Network Open | JAMA Network
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Invited Commentary
May 31, 2019

Tonsillectomy for the Management of Immunoglobulin A Nephropathy

Author Affiliations
  • 1Department of Pediatrics, Division of Nephrology, NYU Langone Health, New York, New York
JAMA Netw Open. 2019;2(5):e194755. doi:10.1001/jamanetworkopen.2019.4755

Considering the global burden of disease associated with IgA nephropathy, it is striking how little data are available about effective therapies for patients. Originally, IgA was seen as a benign entity and the mesangial deposits of IgA that characterize the disease were considered an immunological curiosity. But extended clinical observation confirmed that nearly 30% of affected patients will progress to end-stage kidney disease over 20 to 25 years of follow-up. Immunoglobulin A nephropathy initially requires a genetic predisposition toward the synthesis of IgA 1 molecules with deficient galactosylation of the hinge region of the antibody. This triggers production of autoantibodies, formation of immune complexes, deposition in the glomerular mesangium, and initiation of inflammation.1

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