In a previous study, we demonstrated the benefit of
tonsillectomy for early recovery from Henoch-Schönlein
purpura (HSP)
nephritis (HSPN), suggesting the pathological role of tonsils in HSP (Inoue et al., Clin Nephrol 67:298-305, 2007). In this study, we evaluated the efficacy of extensive eradication of infectious foci directly connected to the tonsils, including those involved in oral as well as ear, nose, and throat (
ENT) diseases, in reducing the nephropathy in HSP. For this purpose, we examined the focal points of
infection in 40 newly diagnosed HSP patients. After these focal points of
infection had been identified, they were extensively eradicated; when the
clinical course was intractable, we also considered
tonsillectomy. After administering such
therapy to HSP patients, we prospectively followed them up for 0.6 to 8 years. The identified
focal infections included
dental caries in 28 (70%),
apical periodontitis in 21 (53%),
rhinosinusitis in 19 (48%),
tonsillitis in five (13%), and
otitis media in four (10%) of the 40 patients. Seventeen patients (43%) had more than two simultaneous infectious foci, whereas, in five (13%), no infectious focus was found. In 32 patients, antimicrobial treatment with concurrent dental and/or ENT
therapy resulted in a complete cure without development of HSPN or recurrent attacks. In eight patients, we performed
tonsillectomy-adenotonsillectomy to treat their clinical symptoms, including aggravated
purpura and recurrent attacks of HSP or HSPN. All patients were completely cured. The overall incidence of HSPN was only three out of the 40 patients (8%). Oral and
ENT diseases were found with high percentages in HSP patients. Early and extensive treatment for these lesions and
tonsillectomy-adenotonsillectomy for intractable cases may prevent the complication of HSPN, contributing to the early curing of HSP.