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      Celiac disease associated membranous nephropathy - a rare cause or coincidence? A case report

      case-report
      1 , 1 , , 1 , 2
      Cases Journal
      Cases Network Ltd

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          Abstract

          Introduction

          Celiac disease is associated with a variety of autoimmune diseases such as type 1 diabetes mellitus, autoimmune thyroid disorders, Sjogren's syndrome and IgA nephropathy, however membranous nephropathy is not recognized amongst one of them.

          Case presentation

          We report a rare case of nephrotic syndrome due to membranous nephropathy in a patient with celiac disease. A 77-years-old male patient presented with uncontrolled hypertension, anemia and acute renal failure. He was diagnosed with celiac disease and membranous nephropathy confirmed by small bowel and renal biopsy. Patient was treated with gluten free diet and immuno-suppressive therapy; however, he died within 2 to 3 months due to myocardial infarction.

          Conclusion

          The association between celiac disease and nephrotic syndrome is extremely rare. Only two adult patients with celiac disease and membranous nephropathy have been reported in the literature so far. Since the prevalence of celiac disease ranges between 0.75% and 4.54%, the question arises whether the coexistence of celiac disease and membranous nephropathy is just a coincidence or a rare association. As they both are immune mediated diseases, a link between them is a strong possibility.

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          Most cited references6

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          Prevalence of celiac disease in at-risk and not-at-risk groups in the United States: a large multicenter study.

          Celiac disease (CD) is an immune-mediated enteropathic condition triggered in genetically susceptible individuals by the ingestion of gluten. Although common in Europe, CD is thought to be rare in the United States, where there are no large epidemiologic studies of its prevalence. The aim of this study was to determine the prevalence of CD in at-risk and not-at-risk groups in the United States. Serum antigliadin antibodies and anti-endomysial antibodies (EMA) were measured. In EMA-positive subjects, human tissue transglutaminase IgA antibodies and CD-associated human leukocyte antigen DQ2/DQ8 haplotypes were determined. Intestinal biopsy was recommended and performed whenever possible for all EMA-positive subjects. A total of 13 145 subjects were screened: 4508 first-degree and 1275 second-degree relatives of patients with biopsy-proven CD, 3236 symptomatic patients (with either gastrointestinal symptoms or a disorder associated with CD), and 4126 not-at-risk individuals. In at-risk groups, the prevalence of CD was 1:22 in first-degree relatives, 1:39 in second-degree relatives, and 1:56 in symptomatic patients. The overall prevalence of CD in not-at-risk groups was 1:133. All the EMA-positive subjects who underwent intestinal biopsy had lesions consistent with CD. Our results suggest that CD occurs frequently not only in patients with gastrointestinal symptoms, but also in first- and second-degree relatives and patients with numerous common disorders even in the absence of gastrointestinal symptoms. The prevalence of CD in symptomatic patients and not-at-risk subjects was similar to that reported in Europe. Celiac disease appears to be a more common but neglected disorder than has generally been recognized in the United States.
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            Celiac sprue.

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              The many faces of celiac disease: clinical presentation of celiac disease in the adult population.

              The major modes of presentation of patients with celiac disease are the classic diarrhea-predominant form and silent celiac disease. Those with silent celiac disease lack diarrhea, although they may present with manifestations of celiac disease that include an irritable bowel syndrome, anemia, osteoporosis, neurologic diseases, or malignancy. A significant proportion of patients are diagnosed through screening at-risk groups including relatives of patients and insulin-dependant diabetics. Nondiarrheal presentations now are seen more commonly than those with diarrhea. Patients with celiac disease have a greater burden of disease than the general population because of autoimmune diseases and malignancies. There is a need for screening studies of patients with conditions associated with celiac disease to determine whether the large numbers of people with undiagnosed celiac disease currently are seeking health care.
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                Author and article information

                Journal
                Cases J
                Cases Journal
                Cases Network Ltd
                1757-1626
                18 June 2009
                2009
                : 2
                : 7018
                Affiliations
                [1 ]simpleDepartment of Internal Medicine, Drexel University College of Medicine - Saint Peter's University Hospital 254 Easton Avenue, New Brunswick, NJ 08901USA
                [2 ]simpleDepartment of Internal Medicine and Nephrology, Drexel University College of Medicine - Saint Peter's University Hospital 254 Easton Avenue, New Brunswick, NJ 08901USA
                Article
                7018
                10.4076/1757-1626-2-7018
                2740114
                19829897
                84b9691c-77ea-4a04-81a3-9bd1891aa0e4
                © 2009 Prasad et al.; licensee Cases Network Ltd.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 01 April 2009
                : 30 April 2009
                Categories
                Case report

                Medicine
                Medicine

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