Today’s topic is about how to dispose of the tonsils in kidney disease patients. The tonsils are one of the body’s immunologically active organs, producing lymphocytes and antibodies to directly fight bacteria and viruses that invade the body, just like a guard guarding the body’s border with the outside world. Since the tonsils are at the crossroads between the diet and the respiratory tract, they may be irritated from time to time by exogenous foods that are ingested through the mouth daily or by germs that are hidden locally, stimulating an inflammatory response. If the tonsils react strongly to exogenous stimuli, it will certainly bring about a local or even systemic inflammatory process (such as severe sore throat, breathing difficulties, fever, etc.), and for some patients with kidney disease, it may also cause a relapse or aggravate the disease (in addition to the symptoms caused by tonsillitis, it may also be combined with sarcoid hematuria, severe back pain, swelling and deterioration of kidney function, etc.). Therefore, the need for removal of tonsils in patients with kidney disease has always been a concern for clinical doctors. I have been studying the effect of tonsils on IGA nephropathy since the early 1980s, and I am also the first to implement tonsil removal in China for the treatment of IGA nephropathy, and after more than 30 years of research and observation, I feel deeply that tonsil removal is simple, but the treatment effect varies greatly between patients with different nephropathies. Therefore, it is necessary to make a comprehensive assessment of the lymphocyte function and disease situation of the kidney disease patients before determining the removal of the tonsils, my views are as follows: 1. It produces both antibodies and lymphocytes that protect the body and is the body’s first line of immune defense, but if the immune response is excessive, it can trigger local and systemic inflammatory reactions; therefore, frequent inflammatory episodes of the tonsils can be considered for removal; if their inflammatory episodes are infrequent, the protective role of the tonsils on the body is more dominant at this time, and it is a pity to remove it. 2, tonsils will gradually shrink with age tonsils will gradually shrink with age, its function also declined, so some children or adolescent patients with enlarged tonsils may wish to wait a little longer to observe whether its shrinkage also recurring inflammatory reactions, if the frequency of tonsillitis episodes with age and reduced can be removed slowly. 3, whether the condition is associated with tonsils The condition is enough to be associated with tonsils. In many kidney diseases, only patients with IGA nephropathy with recurrent granulomatous hematuria and acute post-streptococcal infection nephritis are closely related to tonsillitis, other types of nephritis and tonsillitis are only affected by local inflammation, but not a clear causal relationship. 4, tonsils can not replace other treatments for kidney disease Tonsil removal is not etiological treatment, only a temporary solution to the trigger link that causes local inflammation, can not replace other treatments for kidney disease (immunomodulatory therapy, regulation of renal workload, antihypertensive therapy, etc.). 5.Some patients have a transient aggravation after tonsil removal Some patients have a transient aggravation within a week after tonsil removal, combined with hematuria and proteinuria, which is good for most of these patients, proving that there is a close relationship between tonsil events and kidney disease, and tonsil removal is beneficial to the improvement of the disease and the reduction of the number of recurrence of kidney disease. The remission of these symptoms does not last more than 3 months after surgery. No excessive treatment is needed at this stage, and attention to reducing local irritation (spicy food, cold air) is sufficient. 6.Some patients have increased symptoms of pharyngitis after tonsil removal A significant number of patients have increased symptoms of pharyngitis after tonsil removal, highlighted by a large number of lymphatic follicles in the posterior pharyngeal wall, suggesting that these patients have hyperfunctional lymphatic system and removal of tonsils does not help to relieve the disease. There is no evidence-based study to prove that tonsil removal can improve the prognosis of kidney disease. Combining a large number of research reports and my clinical experience of more than 30 years in medicine, I take the following attitude towards the need for tonsil removal in patients with kidney disease: for the general population, as long as tonsillitis attacks are not frequent, it is not recommended to remove it easily. For patients with IGA nephropathy with hematuria, if tonsillar attacks are frequent, more than two to three times a year, especially if they are over 25 years old with significantly enlarged tonsils, they can be considered for removal, while patients with other clinical types of IGA nephropathy should be determined at their discretion.