Tonsils are one of the body’s immunologically active organs, which produce lymphocytes and antibodies to directly fight against bacteria and viruses that invade the body, just like an armed guard guarding the border of the body’s contact with the outside world. Since the tonsils are at the crossroads of the diet and the inhalation tract, both the exogenous food that is ingested through the mouth every day and the germs that are hidden in the local area may stimulate it and stimulate an inflammatory response. If the tonsils react strongly to exogenous stimuli, it will inevitably bring about local and even systemic inflammatory processes (such as severe sore throat, difficulty in whistling, fever, etc.), and for some patients with renal disease, it may also cause recurrence or aggravation of the disease (in addition to symptoms caused by tonsillitis, it may also be combined with hematuria, severe lumbar pain, edema, and deterioration of renal function, etc.). Therefore, the need to remove tonsils in patients with renal disease has always been a matter of concern for clinicians. I started to study the effect of tonsil removal on IGA nephropathy since the early 1980s, and I am also the first practitioner to implement tonsil removal to treat IgA nephropathy at home and abroad, after more than three decades of research and observation, I am deeply touched by the fact that tonsil removal surgery is simple, but the treatment effect varies greatly among patients with different clinical types of nephropathy. Therefore, before removing the tonsils, we need to evaluate the lymphocyte function and disease condition of the kidney disease patients, my opinion is as follows: Tonsils are a double-edged sword, the tonsils can produce antibodies and lymphocytes that can protect the human body, and act as the first immunity defense, but if the immune response is excessive, it can also trigger the local or even systemic inflammatory reaction, which can aggravate the renal lesions, therefore, the frequent occurrence of tonsillitis can be considered to be removed. Therefore, frequent tonsillitis attacks can be considered to remove the peace of mind; if its inflammatory episodes occasional or do not occur, this small gland (tonsils) on the human body is still a treasure, at this time it is far more protective effect on the body than the inflammation of the damage brought about by the removal of it a little bit of a pity. Tonsils shrink with age Tonsils shrink with age and their function declines, so children or teenagers with enlarged tonsils may want to wait a little longer to see if inflammation recurs after shrinkage, and if the frequency of tonsillitis decreases with age, then it can be removed at a later date. Whether the disease is related to tonsils Among many kidney diseases, only IgA nephropathy with recurrent hematuria and acute post-streptococcal nephritis are closely related to tonsillitis, while other types of nephritis are only affected by local inflammation, but not a clear causal relationship. Therefore, unless in special circumstances, blind removal of tonsils in common kidney disease patients will do more harm than good. Tonsil removal can not replace other treatments for kidney disease Tonsil removal is not a cause treatment, it only temporarily solves the trigger of local inflammation, and it can not replace other treatments for kidney disease (immunomodulation therapy, regulation of renal workload, antihypertensive therapy, etc.). Some patients have transient exacerbation after tonsil removal Some patients will have transient exacerbation within one week after tonsil removal, such as the combination of hematuria or proteinuria; this phenomenon is a good thing for the majority of nephritis patients who have tonsil removal, which proves that there may be some correlation between tonsil and kidney disease, and that tonsil removal is beneficial to the improvement of the disease, and the reduction of the number of relapses of kidney disease. The relief of these symptoms does not last more than 3 months after surgery. There is no need to over-treat at this stage, and it is sufficient to take care of reducing local irritation (spicy food, cold air). Pharyngitis symptoms worsen after tonsil removal A significant number of patients experience worsening of pharyngitis symptoms after tonsil removal, as evidenced by an increase in the number of lymphoid follicles in the posterior wall of the pharynx, which suggests that these patients have a hyperactive lymphatic system and that tonsil removal will not help to alleviate their condition. Can tonsil removal cure kidney disease? At present, there is no large series of international evidence-based studies proving that tonsillectomy can improve the prognosis of kidney disease. Focus Combining a large number of research reports and my clinical experience of more than 30 years in medicine, I hold the following attitude towards the need of 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 tonsillitis attacks are frequent, more than two to three times a year, especially for those who are over 25 years old with obvious enlargement of tonsils, we can consider removing them as early as possible, while patients with other clinical types of IgA nephropathy have to be evaluated as appropriate to determine.