Investigating the Potential Link Between Chronic Tonsillitis and IgA Nephropathy

IgA nephropathy (IgAN) is a rare and underrepresented autoimmune disease estimated to impact just one in 100,000 people in the U.S. and Europe. However, IgAN is much more prevalent in Asian regions, such as Japan and China.

In addition to its prevalence, detecting IgAN can be difficult, as a kidney biopsy is required for accurate diagnosis. Luckily, researchers are uncovering potential risk factors for the onset of IgAN. A study entitled “Chronic Tonsillitis and IgA Nephropathy: Findings from a Nationwide Japanese Cohort Study” published in the American Journal of Kidney Diseases showed a compelling association between IgAN and chronic tonsilitis.

The study revealed three key discoveries linking IgAN to chronic tonsilitis:

• Participants with a history of chronic tonsillitis exhibited a considerably higher chance of developing IgAN compared to those without reports of chronic tonsillitis.
• The severity and duration of chronic tonsillitis appeared to have a direct correlation with the onset of IgAN, as participants with a prolonged history of severe forms of tonsillitis were at a greater risk.
• While this study included participants of different age groups and genders, the heightened risk of IgAN associated with chronic tonsillitis was particularly notable in younger participants. Males were also more likely to experience IgAN onset.

The exact interrelation between IgAN and chronic tonsillitis is still an area of great curiosity, though it’s believed a bacteria in the mouth called Porphyromonas gingivalis, which also contributes to gum disease, is a possible agent in the onset of IgAN due to the subsequent inflammatory response it triggers. Porphyromonas gingivalis may contribute to systemic inflammation, which can have detrimental effects on the kidney, among other organs.

The study also found that tonsillectomy may be helpful in IgAN remission, as the tonsils are believed to be the initial site of inflammation for IgAN patients. Some patients displayed a stabilization in renal function after tonsillectomy, further suggesting a relationship between oral health and the onset of IgAN.

In order to reduce the risk of IgAN through Porphyromonas gingivalis, researchers advise following best practices for optimal oral hygiene. This can be done by:

• Brushing teeth at least two times daily
• Using dental floss at least once daily
• Avoiding foods and drinks containing excess sugar
• Avoiding tobacco products
• Visiting your dentist at least once a year for check-ups and cleanings

Even those with perfect oral hygiene may not be impervious to developing IgAN, however. The exact cause of IgAN is unclear, though there are some telltale signs to be aware of. These include:

• Bloody urine
• Dark-colored urine, particularly following a viral infection
• Proteinuria, or “foamy” urine

As physicians, there are several strategies we can employ to examine the kidney health of our patients. These include:

• Blood tests to determine the glomerular filtration rate
  • The blood urea nitrogen (BUN) test, which measures the presence of urea nitrogen in the bloodstream
• Urine tests to identify presence of albumin

The institution of newer, more effective IgAN treatments is a primary focus for nephrologists across the globe, and while the vast majority of IgAN patients ultimately develop kidney failure, there is optimism that more innovative therapies can turn the tides.

References:

Nakayama, T. (2024, June 19). Abbreviated information for authors - american journal of kidney diseases. American Journal of Kidney Diseases. https://www.ajkd.org/article/S0272-6386(11)01206-6/fulltext

Nagasawa, Y., Nomura, R., Misaki, T., Ito, S., Naka, S., Wato, K., Okunaka, M., Watabe, M., Fushimi, K., Tsuzuki, K., Matsumoto-Nakano, M., & Nakano, K. (2021a, December 1). Relationship between IGA nephropathy and porphyromonas gingivalis; red complex of periodontopathic bacterial species. International journal of molecular sciences. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8657970/

professional, C. C. medical. (2024a, May 31). Oral Hygiene: Best Practices & Instructions for good routine. Cleveland Clinic. https://my.clevelandclinic.org/health/treatments/16914-oral-hygiene

U.S. Department of Health and Human Services. (n.d.-a). IGA nephropathy - niddk. National Institute of Diabetes and Digestive and Kidney Diseases. https://www.niddk.nih.gov/health-information/kidney-disease/iga-nephropathy#:~:text=have%20IgA%20nephropathy.-,What%20causes%20IgA%20nephropathy?,environment%20may%20play%20a%20role.&text=In%20some%20people%2C%20the%20first,throat%2C%20or%20other%20respiratory%20infection.

U.S. Department of Health and Human Services. (n.d.-a). Chronic kidney disease tests & diagnosis - NIDDK. National Institute of Diabetes and Digestive and Kidney Diseases. https://www.niddk.nih.gov/health-information/kidney-disease/chronic-kidney-disease-ckd/tests-diagnosis