The risk of renal comorbidities in celiac disease patients depends on the phenotype of celiac disease

Abstract

Background. An increased risk of kidney disease in patients with celiac disease has been reported, but the association has remained obscure. Only few studies have investigated the association between renal comorbidities and dermatitis herpetiformis, a cutaneous manifestation of celiac disease.Objectives. We investigated whether patients with different phenotypes of celiac disease are at higher risk of kidney diseases than age-and sex-matched references.Methods. The diagnoses of glomerulonephritis, diabetic nephropathy, interstitial nephritis, and endstage renal disease obtained from the National Hospital Discharge Register between 1970 and 2015 were identified in celiac disease (Marsh III, n = 1072) and dermatitis herpetiformis (n = 368) patients diagnosed at Tampere University Hospital catchment region and in 4296 reference subjects. Using the Cox proportional hazards model, we compared the risk of kidney diseases between patients and references. The study protocol was approved by the Regional Ethics Committee of Tampere University Hospital (R16090). As the study was register based, no consent from patients was required.Results. Even after adjusting for type 1 diabetes, celiac disease was associated with an elevated risk of kidney disease (hazard ratio [HR] 1.85, 95% confidence interval [CI] 1.12-3.03), glomerulonephritis (HR 3.37, 95% CI 1.64-6.95), and IgA nephropathy (IgAN) (HR 18.98,. No similarly elevated risk was found among dermatitis herpetiformis patients (HR 1.50, HR 2.21, and HR 5.87, respectively). Conclusion.Celiac disease patients were at increased risk of kidney diseases, notably IgAN. The risk was dependent on the celiac disease phenotype and was not seen in patients with dermatitis herpetiformis. Awareness of possible renal manifestations is recommended when treating celiac disease patients.

Regarding: The risk of renal comorbidities in celiac disease patients depends on the phenotype of celiac disease

“…We have read with great interest the recently published article by Nurmi et al [1]. The authors performed a cohort study with long-term data and reported that celiac-disease patients were at increased risk of kidney disease, which was dependent on the celiac-disease phenotype.…”

Authors' reply: The risk of renal comorbidities in celiac disease patients depends on the phenotype of celiac disease

“…Dear Editor, We thank Dr Han and Dr Gao for their interest and important comments [1] regarding our recently published article in the Journal of Internal Medicine [2]. First, they requested more consideration with matching factors.…”

Unraveling chronic kidney disease in children: a surprising manifestation of celiac disease

“…The prevalence of CD is increased among individuals with chronic kidney disease (CKD), as evidenced by current studies ( 15 ). Also, an increased risk of end-stage renal disease (ESRD) has been associated with CD ( 16 ).…”