IgA nephropathy associated with coeliac disease

Habura, Ireneusz; Fiedorowicz, Katarzyna; Woźniak, Aldona; Idasiak-Piechocka, Ilona; Kosikowski, Paweł; Oko, Andrzej

doi:10.5114/ceji.2019.84021

Cited by 12 publications

(11 citation statements)

References 11 publications

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“…Патологический ответ на пищевые антигены или условно-патогенную флору сопровождается синтезом аберрантно гликозилированных полимеров IgA1, которые в конечном счете попадают в кровоток и откладываются в почках в составе депозитов [5]. В мировой литературе описаны немногочисленные клинические наблюдения связи IgA-нефропатии и целиакии [6,7], имеются данные экспериментальных исследований, указывающих на возможную связь этих заболеваний [8,9], а также результаты исследований, направленных на изучение эффективности безглютеновой диеты в рамках терапевтической коррекции IgA-нефропатии у пациентов с нарушением обмена глютена на небольшой выборке больных [9]. IgA-нефропатия представляет собой наиболее распространенную форму первичного гломерулонефрита в мире [10].…”

Section: Discussionunclassified

Case report: in focus IgA nephropathy as a gluten-related disorder

Манцаева¹,

Борисов²,

Стремоухов³

2021

Лечащий Врач

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Почки могут вовлекаться в патологический процесс при целиакии как в связи с тяжелыми метаболическими нарушениями, так и в качестве ассоциированного заболевания. В мировой литературе имеются данные о различных типах поражения почек у пациентов с целиакией, включая IgA-нефропатию, диабетическую нефропатию, мембранозную нефропатию, мембранозно-пролиферативный гломерулонефрит, нефротический синдром, связанный с мальабсорбцией, оксалатную нефропатию и ассоциацию целиакии с хронической болезнью почек и терминальной почечной недостаточностью. В статье приводится клинический случай 46-летнего мужчины с выявленным нарушением обмена глютена, заподозренным и диагностированным после верификации хронического гломерулонефрита. Отсутствие характерных клинических проявлений со стороны желудочно-кишечного тракта, повышенные титры антител IgA к тканевой трансглютаминазе и деамидированным пептидам глиадина, морфологическая картина слизистой оболочки 12-перстной кишки не давали оснований в пользу диагноза «целиакия», но указывали на наличие нарушений обмена глютена. Пациенту назначена безглютеновая диета на 6 месяцев. В результате наблюдалось улучшение клинико-лабораторных показателей – более стабильные цифры артериального давления на стандартной гипотензивной терапии, снижение суточной протеинурии, гематурии и титров антител IgA к тканевой трансглютаминазе и деамидированным пептидам глиадина. Очевидно, что введение безглютеновой диеты в рацион пациентов с IgA-нефропатией может улучшить клинико-лабораторные показатели, такие как артериальное давление, суточная протеинурия, гематурия, и, вероятно, отсрочить прогрессирование хронической болезни почек. The kidneys can be involved in the pathological process in celiac disease, both in connection with severe metabolic disorders, and as an associated disease. In total, there is evidence of various types of kidney damage in patients with celiac disease, including IgA nephropathy, diabetic nephropathy, membranous nephropathy, membranoproliferative glomerulonephritis, nephrotic syndrome associated with malabsorption, oxalate nephropathy, and the association of celiac disease with chronic renal disease and terminal renal insufficiency in the literature. We describe a case of a 46-year-old man with gluten-related disorders. Given the absence of typical clinical manifestations from the gastrointestinal tract, increased antibodies IgA to tissue transglutaminase and deamidated gliadin peptides, the morphological picture of the duodenal mucosa, do not give grounds for diagnosing celiac disease, but indicate the presence of a gluten-related disorders in the patient. The patient was prescribed a gluten-free diet for a period of 6 months. As a result, an improvement in clinical and laboratory parameters was observed: more stable blood pressure values on standard antihypertensive therapy, a decrease in proteinuria, hematuria, and antibody IgA to tissue transglutaminase and deamidated gliadin peptides. The introduction of a gluten-free diet in the diet of patients with IgA-nephropathy can improve clinical and laboratory parameters, such as blood pressure, proteinuria, hematuria, and probably delay the progression of chronic renaldisease.

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Section: Discussionunclassified

Case report: in focus IgA nephropathy as a gluten-related disorder

Манцаева¹,

Борисов²,

Стремоухов³

2021

Лечащий Врач

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“…Secondary IgAN associated with autoimmune disorders, including Sjogren’s disease, ankylosing spondylitis and coeliac disease, has been reported in the literature[ 2 , 12 , 13 ]. However, IgAN with AIH has been reported in only a limited number of patients, and most of them had other autoimmune diseases such as Sjogren’s disease which is often reported to be associated with IgAN[ 14 , 15 ].…”

Section: Discussionmentioning

confidence: 99%

Autoimmune hepatitis in a patient with immunoglobulin A nephropathy: A case report

Jeon

Kim

Lee

et al. 2020

WJCC

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BACKGROUND Immunoglobulin A nephropathy (IgAN) is the most commonly encountered glomerular disease in Asian countries. It has a broad clinical presentation, and it is frequently associated with other conditions. Chronic liver disease is well recognized as the leading cause of secondary IgAN. However, cases of IgAN associated with autoimmune hepatitis (AIH) have seldom been reported. CASE SUMMARY A 63-year-old Korean woman was admitted to Pusan National University Hospital for an evaluation of abdominal pain and elevated liver enzymes. Two weeks prior, she had presented to our hospital with proteinuria of approximately 1350 mg/d and hematuria and was diagnosed with IgAN. Autoimmune profiles were highly positive for antinuclear antibodies, and symptoms related to portal hypertension including ascites and peripheral edema were present. A diagnosis of AIH was made according to the simplified scoring system of the International Autoimmune Hepatitis Group. Despite immunosuppression with prednisolone and azathioprine, rapid deterioration of liver function led to end-stage liver disease. After a living-donor liver transplantation, liver function gradually improved, and she had maintained stable liver and kidney function at the six months follow-up. CONCLUSION Cases of secondary IgAN with chronic liver disease have been frequently reported in the literature but are rarely associated with AIH. We encountered an IgAN patient with concurrent progressive liver failure due to AIH.

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“…Budesonide has been used to treat patients with asthma, inflammatory bowel disease, and allergic rhinitis, and its enteric-coated sustained-release capsule was demonstrated to decrease the level of proteinuria in patients with IgAN, indicating a reduced risk of future progression to end-stage renal disease 62 . Similarly, in celiac disease, gluten-free diets have been reported to decrease the levels of proteinuria and mitigate immune disorders in patients with IgAN, showing reduced levels of antiendomysium antibodies 63 . Thus, further research is needed to determine the role of GALT in the pathogenesis of IgAN.…”

Section: The Mucosal Origin Of Gd-iga1mentioning

confidence: 96%

Perspectives on how mucosal immune responses, infections and gut microbiome shape IgA nephropathy and future therapies

He¹,

Zhou²,

Lv³

et al. 2020

Theranostics

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Infections have been considered to play a critical role in the pathogenesis of IgA nephropathy (IgAN) because synpharyngitic hematuria is a common feature in IgAN. However, how infections participate in this process is still debated. More recent studies have also revealed that the alteration of the gut microbiome exerts a profound effect on host immune responses, contributing to the etiology or progression of autoimmunity. Considering IgA as the first line of defense against bacterial and viral antigens, this review evaluates the relationships among intestinal infections, gut microbiome, and IgA for a better understanding of the pathogenesis of IgAN. Moreover, as a prototype of IgA immunity, we provide detailed clarification of IgAN pathogenesis to shed light on other diseases in which IgA plays a role. Finally, we discuss potential therapies focusing on microbes and mucosal immune responses in IgAN.

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IgA nephropathy associated with coeliac disease

Cited by 12 publications

References 11 publications

Case report: in focus IgA nephropathy as a gluten-related disorder

Case report: in focus IgA nephropathy as a gluten-related disorder

Autoimmune hepatitis in a patient with immunoglobulin A nephropathy: A case report

Perspectives on how mucosal immune responses, infections and gut microbiome shape IgA nephropathy and future therapies

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