Your Tonsils May Be Triggering a Kidney Disease—Here's What Scientists Are Learning

Scientists have discovered that tonsils may be producing defective antibodies that trigger IgA nephropathy, a kidney disease that affects millions worldwide. This groundbreaking research is revealing why some people develop this condition after throat infections and how removing tonsils might help treat it.

What Is IgA Nephropathy and Why Should You Care?

Immunoglobulin A (IgA) nephropathy is the most common form of kidney inflammation globally. It happens when faulty IgA antibodies—specifically ones missing important sugar molecules called galactose—form clumps that get stuck in the kidney's filtering units. These deposits cause inflammation and can eventually lead to kidney failure if left untreated.

What makes this disease particularly puzzling is its connection to upper respiratory infections. Many patients notice blood in their urine right after getting a throat infection, a phenomenon doctors call "synpharyngitic hematuria." This timing isn't coincidental—it's a crucial clue about where the problematic antibodies come from.

How Do Tonsils Create Kidney Problems?

Your body produces more IgA antibodies than any other type—up to 70 milligrams per kilogram of body weight daily. Most of this production happens in mucosal tissues like your tonsils, which are constantly exposed to bacteria and viruses.

Researchers have identified that the problem starts with faulty sugar processing in antibody-producing cells. When these cells don't properly attach galactose molecules to IgA1 antibodies, the result is galactose-deficient IgA1 (Gd-IgA1). These defective antibodies are more likely to clump together and cause kidney damage.

The production of these problematic antibodies can be triggered by several factors:

• Genetic Susceptibility: Genome-wide studies have identified multiple genes associated with IgA nephropathy, including some that control antibody production and tonsil function
• Inflammatory Signals: Certain cytokines (immune system messengers) can upregulate the production of galactose-deficient antibodies
• Enzyme Dysfunction: Problems with O-glycosylation enzymes that normally add sugar molecules to antibodies

Why Japanese Doctors Remove Tonsils to Treat Kidney Disease?

In Japan, doctors commonly perform tonsillectomies as part of IgA nephropathy treatment—a practice that might seem unusual but is backed by emerging science. The reasoning is straightforward: if tonsils are producing the faulty antibodies causing kidney damage, removing them should reduce the source of the problem.

Recent genetic studies support this approach. Researchers found that the HORMAD2/LIF gene locus is associated with IgA nephropathy, blood IgA levels, and the likelihood of needing tonsil removal. This genetic connection helps explain why some people benefit more from tonsillectomy than others.

The research also shows promise for targeted drug treatments. A medication called Tarpeyo, designed to release the steroid budesonide specifically in the intestinal area where many IgA-producing cells originate, has shown significant success in reducing protein in the urine—a key marker of kidney damage. This targeted approach received accelerated FDA approval based on phase III trial results.

Understanding how tonsils contribute to kidney disease opens new possibilities for both prevention and treatment. For people with recurring throat infections and unexplained kidney problems, this research provides hope for more targeted therapies that address the root cause rather than just managing symptoms.