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Abstract: TH-PO1029

Pathologic Tonsillar Findings Similar to Immunoglobulin A Nephropathy in Patients with Frequently Relapsing Nephrotic Syndrome

Session Information

Category: Glomerular Diseases

  • 1203 Glomerular Diseases: Clinical, Outcomes, and Trials


  • Sugimoto, Keisuke, Kindai University Faculty of Medicine, Osaka, Japan
  • Miyazaki, Kohei, Department of Pediatrics, Kinki University School of medicine, Osaka, Japan
  • Enya, Takuji, kinki university school of medicine, Osakasayama, Japan
  • Miyazawa, Tomoki, kindai University Faculty of Medicine, Izumi, Osaka-Fu, Japan
  • Okada, Mitsuru, Kindai University Faculty of Medicine, Osaka, Japan
  • Takemura, Tsukasa, Kushimoto Municipality Hospital, Higashimurogun, Japan

Several studies have reported that regulatory T (Treg) cells are of critical importance for maintenance of tolerance in not only immunoglobulin A nephropathy (IgAN) but also nephrotic syndrome (NS).
The pathologic tonsillar findings in IgAN differ significantly from those in chronic tonsillitis. However, the pathologic tonsillar features in patients with NS are unclear.


Immunohistochemical staining for tonsillar CD4, CD8, HLA-DR and cytokeratin was performed in 8 patients with frequently relapsing nephrotic syndrome (FRNS) who underwent tonsillectomy for chronic tonsillitis,. The patients were in complete remission, and were followed on low-dose prednisolone for FRNS.


In 6 of 8 patients, T-cell nodules were enlarged by infiltration of HLA-DR-positive cells. Infiltration with both CD4-positive and CD8-positive cells was prominent in interfollicular areas. Cytokeratin staining showed that the layer of crypt epithelium was replaced by squamous epithelium.


The efficacy of tonsillectomy for IgAN is thought to be due to regulation of tolerance abnormalities. Replacement from the layer of crypt epithelium implies involution of lymphoepithelial symbiosis. The distribution of CD4 and CD8 is characteristic in the tonsils of those with IgAN. These pathologic findings in FRNS patients suggest the existence of a similar tolerance abnormality in the tonsils of those with NS.
Our results may help to clarify intolerance in NS. Further studies are necessary to clarify the clinical efficacy of tonsillectomy for NS patients.