Coeliac sprue-associated membranoproliferative glomerulonephritis (MPGN).
Coeliac sprue (CS) may occur in association with immune complex-mediated diseases, including IgA nephropathy, dermatitis herpetiformis and thyroiditis. An association of CS with membranoproliferative glomerulonephritis (MPGN) type 1 is rare, with only two prior cases reported. Here we describe a 45-year-old man with no prior medical history who presented initially with microhaematuria, subnephrotic proteinuria and hypocomplementaemia. A renal biopsy revealed MPGN type 1 with negative serologic workup for secondary causes. The patient was treated conservatively with angiotensin-converting enzyme inhibitors. Several months later, he developed daily non-bloody diarrhoea and was found to have worsening hypoalbuminaemia, hypophosphataemia and severe iron deficiency anaemia. A diagnosis of CS was established based on elevated tTGA (IgA anti-tissue transglutaminase) antibody and positive IgA antiendomysial antibody titres. Proteinuria resolved completely following the initiation of a gluten-free diet, without the use of immunosuppressive therapy and despite tapering of angiotensin-converting enzyme inhibitor. This case illustrates that CS-associated MPGN may precede overt clinical evidence of coeliac disease and may respond to gluten-free diet, without resort to immunosuppressive therapy.
Jhaveri
Kenar D
KD
Division of Nephrology and Hypertension, New York Presbyterian Hospital at Weill Cornell Medical Centre, College of Physicians and Surgeons, Columbia University, New York, NY, USA. Kdj200@gmail.com
D'Agati
Vivette D
VD
Pursell
Robert
R
Serur
David
D
D002446:Celiac Disease / Q000150:complications* / Q000276:immunology / Q000628:therapy; D015432:Glomerulonephritis, Membranoproliferative / Q000209:etiology* / Q000473:pathology; D006801:Humans; D007070:Immunoglobulin A / Q000097:blood; D007668:Kidney / Q000473:pathology; D008297:Male; D008875:Middle Aged
D007070:Immunoglobulin A