Kidney Week

Abstract: TH-PO1029

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

Session Information

• Glomerular Diseases: Clinical, Outcomes, Trials - I
  October 25, 2018 | Location: Exhibit Hall, San Diego Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Glomerular Diseases

• 1203 Glomerular Diseases: Clinical, Outcomes, and Trials

Authors

• Sugimoto, Keisuke, Kindai University Faculty of Medicine, Osaka, Japan

Keisuke Sugimoto,

• Miyazaki, Kohei, Department of Pediatrics, Kinki University School of medicine, Osaka, Japan

Kohei Miyazaki,

• Enya, Takuji, kinki university school of medicine, Osakasayama, Japan

Takuji Enya,

• Miyazawa, Tomoki, kindai University Faculty of Medicine, Izumi, Osaka-Fu, Japan

Tomoki Miyazawa,

• Okada, Mitsuru, Kindai University Faculty of Medicine, Osaka, Japan

Mitsuru Okada,

• Takemura, Tsukasa, Kushimoto Municipality Hospital, Higashimurogun, Japan

Tsukasa Takemura,

Background

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.

Methods

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.

Results

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.

Conclusion

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.