The role of tonsillectomy in the treatment of IgA nephropathy remains controversial. To assess the efficacy of this procedure in the remission of progressive IgA nephropathy, Isseki Maeda et al. at Osaka City University Graduate School of Medicine in Japan conducted a 7-year single-center longitudinal cohort study. The criterion for effectiveness was the absence of abnormalities in routine urinalysis for two consecutive years, and a decrease in glomerular filtration rate (GFR) was defined as a decrease in GFR of 30% or more from baseline during follow-up. A total of 200 patients with pathologically biopsy-proven IgA nephropathy were enrolled, 70 of whom underwent tonsillectomy. The results found that tonsillectomy was positively associated with clinical remission rates and that patients had a significantly lower incidence of decreased GFR; after adjusting for confounders such as age and sex, the risk ratios (hazard ratio, HR) were 3.90 and 0.14, respectively. in-depth analysis, adjusting for histological, laboratory tests, and therapeutic variables, led to similar conclusions. The annual variation of GFR in patients in the surgical and non-surgical groups was 0.60 ± 3.65 and ? 1.64 ± 2.59 mL/min/1.73 m2/y. This advantage in preventing GFR decline was present even in the 69 patients who were not treated with glucocorticoids. In a multiple regression model, tonsillectomy also showed the advantage of being able to prevent GFR decline in long-term follow-up with a regression coefficient of 2.0.