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NDT Advance Access originally published online on July 22, 2009
Nephrology Dialysis Transplantation 2009 24(11):3545-3548; doi:10.1093/ndt/gfp353
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© The Author 2009. Published by Oxford University Press [on behalf of ERA-EDTA]. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org


Coeliac sprue-associated membranoproliferative glomerulonephritis (MPGN)

Kenar D. Jhaveri1, Vivette D. D’Agati2, Robert Pursell3 and David Serur1,4

1 Division of Nephrology and Hypertension, New York Presbyterian Hospital at Weill Cornell Medical Centre 2 Department of Pathology, College of Physicians and Surgeons, Columbia University, New York, NY 3 Lehigh Valley Nephrology Associates, Fountain Hill, PA 4 The Rogosin Institute, New York, NY, USA

Correspondence and offprint requests to: Kenar D. Jhaveri; E-mail: Kdj200{at}gmail.com



  Abstract

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.

Keywords: coeliac sprue; glomerular disease; glomerulonephritis; membranoproliferative; MPGN

Received for publication: 9. 6.09
Accepted in revised form: 25. 6.09


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