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Saudi Journal of Kidney Diseases and Transplantation
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Year : 2014  |  Volume : 25  |  Issue : 4  |  Page : 893-894
Celiac disease a rare cause of nephrogenic ascites

Department of Pediatrics, Al-Kindy College of Medicine, Baghdad University, Baghdad, Iraq

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Date of Web Publication24-Jun-2014

How to cite this article:
Al-Mendalawi MD. Celiac disease a rare cause of nephrogenic ascites. Saudi J Kidney Dis Transpl 2014;25:893-4

How to cite this URL:
Al-Mendalawi MD. Celiac disease a rare cause of nephrogenic ascites. Saudi J Kidney Dis Transpl [serial online] 2014 [cited 2021 Dec 3];25:893-4. Available from: https://www.sjkdt.org/text.asp?2014/25/4/893/135204
To the Editor,

This letter is in reference to the interesting case report by Al-Bderat et al. [1] Several others also have reported that immune characteristics associated with celiac disease (CD) increases the risk of chronic kidney diseases (CKD) like IgA nephropathy, [2] membranous glomerulo-nephritis, [3] membranoproliferative glomerulo-nephritis, [4] urolithiasis [5] and nephrotic syn-drome. [6] Also, individuals with biopsy-verified CD suffer an increased risk of subsequent end-stage renal disease. [7] Such marked correlation between CD and CKD has triggered the need for screening for CD in the CKD population and, recently, such screening has been found to be useful. In a recently published Turkish study, anti-endomysial IgA (EMA) antibody was screened in patients with CKD (glome-rular filtration rate <60 mL/min). Patients who were EMA positive underwent upper gastro­intestinal system endoscopy and intestinal biopsy for confirmation of definite diagnosis for CD. The study showed a 2.39% prevalence of CD in patients with CKD. Interestingly, there was no statistically significant difference between the two groups according to age and gender. Apparent chronic gastrointestinal symp­toms such as abdominal pain, distension, cons­tipation and diarrhea were absent in patients diagnosed with CD. Moreover, the differences between some laboratory parameters (such as complete blood count, albumin, calcium, phos­phate, total cholesterol, ferritin, parathormone) of CD and non-CD patients were not statistically significant. [8] I do stress that the case report by Al-Bderat et al [1] should increase the alertness of pediatricians to the presence of occult CD in CKD patients and that screening of such patients for CD ought to be considered even with the absence of clinical manifesta­tions suggestive of CD.

Authors Reply

To the Editor ,

With reference to the comment by Prof. Al-Mendalawi, I would like to thank him and extend my appreciation to the comment he made; however, the association between celiac disease (CD) and chronic kidney diseases (CKD) is not as strong as that between CD and other immune-mediated diseases to recommend routine screening for CD in all patients with CKDs. In our center, of 90 patients who already underwent kidney transplant and more than 300 patients with CKD, this is the only case who was found to have CD.

I think the possibility of CD should be con­sidered only in CKD patients who present with symptoms suggestive of CD. The European Society for Paediatric Gastroenterology, Hepa-tology and Nutrition (ESPGHAN) guidelines do not recommend screening CD patients for CKD.

Dr. Issa Hazza,

Pediatric Department,

Queen Rania Alabdullah Hospital of Pediatrics, King Hussein Center, Amman, Jordan

   References Top

1.Al-Bderat J, Hazza I, Haddad R. Celiac disease a rare cause of nephrogenic ascites. Saudi J Kidney Dis Transpl 2013;24:1262-4.  Back to cited text no. 1
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2.Smerud HK, Fellstrom B, Hällgren R, Osagie S, Venge P, Kristjánsson G. Gluten sensitivity in patients with IgA nephropathy. Nephrol Dial Transplant 2009;24:2476-81.  Back to cited text no. 2
3.Soro S, Sánchez de la Nieta MD, Rivera F. Coeliac disease and membranous nephropathy. Nefrologia 2009;29:479-81.  Back to cited text no. 3
4.Biyikli NK, Gokçe I, Cakalaðoðlu F, Arbak S, Alpay H. The co-existence of membrano-proliferative glomerulonephritis type 1 and coeliac disease: A case report. Pediatr Nephrol 2009;24:1247-50.  Back to cited text no. 4
5.Ludvigsson JF, Zingone F, Fored M, Ciacci C, Cirillo M. Moderately increased risk of urinary stone disease in patients with biopsy-verified coeliac disease. Aliment Pharmacol Ther 2012; 35:477-84.  Back to cited text no. 5
6.Vega J, Díaz R, Méndez GR, Goecke H. Nephrotic syndrome and acute kidney injury associated with celiac disease: Report of one case. Rev Med Chil 2013;141:381-7.  Back to cited text no. 6
7.Welander A, Prütz KG, Fored M, Ludvigsson JF. Increased risk of end-stage renal disease in individuals with coeliac disease. Gut 2012; 61:64-8.  Back to cited text no. 7
8.Sahin I, Eminbeyli L, Andic S, Tuncer I, Koz S. Screening for celiac disease among patients with chronic kidney disease. Ren Fail 2012; 34:545-9.  Back to cited text no. 8

Correspondence Address:
Mahmood Dhahir Al-Mendalawi
Department of Pediatrics, Al-Kindy College of Medicine, Baghdad University, Baghdad
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DOI: 10.4103/1319-2442.135204

PMID: 24969212

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