Journal - Nephrology Dialysis Transplantation

Abstract :

Coeliac sprue (CS) may occur in association with immune complex-mediateddiseases, including IgA nephropathy, dermatitis herpetiformisand thyroiditis. An association of CS with membranoproliferativeglomerulonephritis (MPGN) type 1 is rare, with only two priorcases reported. Here we describe a 45-year-old man with no priormedical history who presented initially with microhaematuria,subnephrotic proteinuria and hypocomplementaemia. A renal biopsyrevealed MPGN type 1 with negative serologic workup for secondarycauses. The patient was treated conservatively with angiotensin-convertingenzyme inhibitors. Several months later, he developed dailynon-bloody diarrhoea and was found to have worsening hypoalbuminaemia,hypophosphataemia and severe iron deficiency anaemia. A diagnosisof CS was established based on elevated tTGA (IgA anti-tissuetransglutaminase) antibody and positive IgA antiendomysial antibodytitres. Proteinuria resolved completely following the initiationof a gluten-free diet, without the use of immunosuppressivetherapy and despite tapering of angiotensin-converting enzymeinhibitor. This case illustrates that CS-associated MPGN mayprecede overt clinical evidence of coeliac disease and may respondto gluten-free diet, without resort to immunosuppressive therapy.