We proposed the following indication criteria for tonsillectomy in patients with IgA nephropathy. (1) IgA nephropathy has been definitively diagnosed by an evaluation of the renal glomeruli during renal biopsy. (2) Tonsillectomy is indicated for patients who demonstrate grade I-III renal pathology and a serum creatinine level of 2.0 mg/dl or less during renal biopsy. However, even among patients who demonstrate grade IV disease or a serum creatinine level higher than 2.0 mg/dl during renalbiopsy, surgery should be considered in the absence of contraindications for tonsillectomy, such as renal hypofunction, providing the patient wants to undergo surgery and informed consent is obtained. (3) The patient's medical history includes deterioration of urine findings during tonsillitis or acute upper respiratory inflammation.(4) Buried tonsils and the attachment of pus plugs to the tonsillar crypt are observed as local findings of the palatine tonsil. (5) Positive findings, especially positive urine findings (hematuria), are detected on the tonsillar provocation test. Items (1) and (2) are essential. Items (3) to (5) are indicative, as their inclusion has not been supported by previous studies.