Prevalence of Inflammatory Bowel Disease and Celiac Disease in Patients with IgA Nephropathy over Time

Abstract

<b><i>Introduction:</i></b> IgA nephropathy (IgAN) has been connected with increased intestinal permeability and subclinical intestinal mucosal inflammation as well as with inflammatory bowel disease (IBD) and celiac disease – nevertheless, the results are controversial. The prevalence of bowel diseases has increased over time in Western populations. Whether similar trend is seen among IgAN patients remains obscure. Our aim was to study the prevalence of IBD and celiac disease in IgAN patients over time. <b><i>Methods:</i></b> The study cohort consisted of altogether 629 patients with newly diagnosed IgAN during years 1976–2012. Data on diagnosis of IBD and celiac disease were retrospectively collected from medical records. Further, to detect unrecognized celiac disease, IgA-class tissue transglutaminase antibodies (tTGA) were measured from serum samples taken at the time of kidney biopsy during years 1980–2012 (defined as screen-detected celiac disease autoimmunity). <b><i>Results:</i></b> The prevalence of IBD among IgAN patients increased over time from 0 to 4.4%, while the prevalence of clinically diagnosed celiac disease decreased from 2.6 to 0.6%. Moreover, the number of screen-detected tTGA-positive cases decreased from the 1980s to the 21st century (2.8–0.7%). <b><i>Conclusion:</i></b> The prevalence of IBD increased over time in IgAN patients, which exceeds the prevalence of 0.6% in Finnish general population. In parallel, the prevalence of celiac disease and screen-detected celiac disease autoimmunity decreased over time. The coexistence of IBD and IgAN is not negligible. Whether this finding is caused by the increase in the prevalence of IBD in the population or shared pathophysiology between IgAN and IBD remains a matter of further studies.

Role of gut–kidney axis in renal diseases and IgA nephropathy

“…The prevalence of IBD in IgAN patients increased over time in a Finnish cohort [69]. This was confirmed recently in a Swedish study of a large cohort of 3963 biopsy-proven IgAN patients [70].…”

The Gut and Kidney Crosstalk in Immunoglobulin A Nephropathy

“…A possible explanation for this findings is that early detection of celiac disease and early restriction from gluten may slow down progression of IgAN and hence decrease the measurable association between both diseases. 89…”

“…A recently published cohort study in Finnish population interestingly found that the prevalence of CD in patients with IgAN had significantly decreased in the past few decades compared with data from the 1970s. A possible explanation for this finding is that early detection of CD and early restriction from gluten may slow down progression of IgAN and hence decrease the measurable association between both diseases (89).…”

Identification of shared gene signatures and molecular mechanisms between chronic kidney disease and ulcerative colitis

“…Growing evidence indicates a complex interplay between CKD and gut dysfunction ( 2 – 14 ). Studies revealed that ulcerative colitis (UC), a chronic inflammatory bowel disease affecting the colon and rectum, has a prevalence ranging from 0 to 4.4% in IgA Nephropathy (IgAN, one of the leading causes of CKD), far higher than the highest morbidity of 0.505% in the general population ( 3 , 15 ). Moreover, IgAN patients with UC displayed more severe renal injury with more proliferation of mesangial cells in renal biopsies ( 4 ).…”