Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2018 May 16;18(1):64.
doi: 10.1186/s12876-018-0792-0.

Case report on pathogenetic link between gluten and IgA nephropathy

Stefano Costa  1 , Giovanni Currò  1 , Salvatore Pellegrino  2 , Maria Cristina Lucanto  1 , Giovanni Tuccari  3 , Antonio Ieni  3 , Giuseppina Visalli  4 , Giuseppe Magazzù  1 , Domenico Santoro  5
Affiliations
Case Reports

Case report on pathogenetic link between gluten and IgA nephropathy

Stefano Costa et al. BMC Gastroenterol. .

Abstract

Background: A relationship between IgA nephropathy (IgAN) and celiac disease (CD) has been reported. We show the pathogenetic link for the first time.

Case presentation: A 39-year-old man with cystic fibrosis (CF) and CF-related diabetes started to present gross hematuria, back pain and headache. At admission, laboratory analysis showed increase in serum creatinine of 1.5 mg/dl, together with hematuria and mild proteinuria (1 g/24 h). He underwent a renal biopsy to investigate the cause of hematuria and renal failure. Biopsy was consistent with IgAN. In view of patient reported dyspepsia, an upper gastrointestinal endoscopy with duodenal biopsies was undertaken and was normal. We looked for mucosal deposits of tTG-2 in the duodenum and the renal mesangium. tTG-2 deposits were found both in the duodenum and in renal biopsies, where they topographically replicated mesangial IgA deposits. After one year on a continued gluten containing diet, the patient developed a Marsh 2 type duodenal pathology.

Conclusions: Our findings suggest a connection between CD and IgAN in terms of an immune-mediated gluten-induced pathogenesis even in the absence of villous atrophy and serum celiac autoantibodies.

Keywords: Celiac disease; IGA nephropathy; Immunofluorescence technique; Pathogenesis; Tissue transglutaminase.

PubMed Disclaimer

Conflict of interest statement

Ethics approval and consent to participate

Not applicable.

Consent for publication

Written informed consent for publication of clinical details and clinical images was obtained from the patient.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Renal biopsy. Immunofluorescence (a) showing mesangial deposition of IgA in green. In b, in red, deposition of TG2. In c, the overlap of red and green, in yellow, showing deposition of a-tTG2. The blue lines show the more intense deposition of IgA and TG2. In d, hematoxylin/eosin stain of renal biopsy
Fig. 2
Fig. 2
Duodenal biopsy. In a, deposition of IgA is showed in green. In b, deposition of TG2 is shown in red. In c, in yellow, the overlap of green and red demonstrating the presence of a-tTG2
Fig. 3
Fig. 3
Duodenal biopsy after one year. In a, hematoxylin/eosin stain showing cryptic hyperplasia. In b, the CD3 immunostained section for the count of intraepithelial lymphocytes
See this image and copyright information in PMC

References

    1. Ventura A, Magazzù G, Greco L. Duration of exposure to gluten and risk for autoimmune disorders in patients with celiac disease. SIGEP Study Group for Autoimmune Disorders in Celiac Disease. Gastroenterology. 1999;117(2):297–303. doi: 10.1053/gast.1999.0029900297. - DOI - PubMed
    1. Collin P, Syrjänen J, Partanen J, Pasternack A, Kaukinen K, Mustonen J. Celiac disease and HLA DQ in patients with IgA nephropathy. Am J Gastroenterol. 2002;97:2572–2576. doi: 10.1111/j.1572-0241.2002.06025.x. - DOI - PubMed
    1. Coppo R, Amore A, Roccatello D. Dietary antigens and primary immunoglobulin A nephropathy. J Am Soc Nephrol. 1992;2(Suppl 10):S173–S180. - PubMed
    1. Papista C, Lechner S, Ben Mkaddem S, LeStang MB, Abbad L, Bex-Coudrat J, Pillebout E, Chemouny JM, Jablonski M, Flamant M, Daugas E, Vrtovsnik F, Yiangou M, Berthelot L, Monteiro RC. Gluten exacerbates IgA nephropathy in humanized micethrough gliadin-CD89 interaction. Kidney Int. 2015;88(2):276–285. doi: 10.1038/ki.2015.94. - DOI - PubMed
    1. Donaldson MR, Zone JJ, Schmidt LA, Taylor TB, Neuhausen SL, Hull CM, Meyer LJ. Epidermal transglutaminase deposits in perilesional and uninvolved skin in patients with dermatitis herpetiformis. J Invest Dermatol. 2007;127:1268–1271. doi: 10.1038/sj.jid.5700682. - DOI - PubMed

Publication types