Azita Sadeghzade
1 
, Hossein Mardanparvar
2,3 , Elham Kebriyaei
4 , Ali Emadzadeh
5 , Ahmad Shajari
6* 1 Oral and Dental Disease Research Center, Department of Oral and Maxillofacial Medicine, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran
2 Department of Nursing, Mother and Child Welfare Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
3 Guissu Research Corporation, Bandar Abbas, Iran
4 Clinical Research Development Unit, Valiasr Hospital, Fasa University of Medical Sciences, Fasa, Iran
5 Department of Internal Medicine, MMS.C., Islamic Azad University, Mashhad, Iran
6 Department of Medicine, YMS. C., Islamic Azad University, Yazd, Iran
Abstract
The NALT–kidney axis describes how mucosal immune outputs reach the systemic circulation and finally the glomerular mesangium. Plasma cells originating in nasopharynx-associated lymphoid tissue (NALT) or tonsillar germinal centers can home to systemic sites, including the bone marrow, sustaining elevated serum galactose-deficient IgA1 (Gd-IgA1). Then, circulating Gd IgA1 forms immune complexes with anti Gd IgA1 IgG/IgA, which deposit in the mesangium and then trigger complement activation, which is across with mesangial proliferation, and extracellular matrix expansion.
Implication for health policy/practice/research/medical education:
Nasopharyngeal immune niches centered in the palatine tonsils and adjacent epipharyngeal lymphoid tissue are now recognized as critical mucosa-associated lymphoid tissue sites that shape both systemic IgA responses and kidney-targeted immunopathology in IgA nephropathy. Within this framework, tonsillar production of galactose-deficient IgA1 (Gd-IgA1) and the propagation of inflammatory signals along a nasopharynx-associated lymphoid tissue (NALT)–kidney axis offer an integrated explanation for synpharyngitic hematuria, the dynamics of glomerular vasculitis, and the clinical benefit of tonsil-focused interventions in selected patients.
Please cite this paper as: Sadeghzade A, Mardanparvar H, Kebriyaei E, Emadzadeh A, Shajari A. Nasopharyngeal immune niches in IgA nephropathy; from tonsillar Gd-IgA1 production to the NALT–kidney axis. J Nephropathol. 2026;x(x):e28719. DOI: 10.34172/jnp.2026.28719.