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Celiac.com 11/04/2024 - Celiac disease is an autoimmune disorder that primarily affects the digestive system, but its influence extends far beyond the gut. When individuals with celiac disease consume gluten, an immune response is triggered that can damage the small intestine and lead to a wide array of health problems. Recent research has been exploring the potential connection between celiac disease and other organ systems, including the kidneys. This study focuses on whether there is a causal relationship between celiac disease and various forms of kidney disease, specifically through genetic predisposition. The researchers used a method called Mendelian randomization to assess this potential link, which helps reduce the chance of bias in observational studies. Methods: Using Genetics to Explore Connections To investigate the possible connection between celiac disease and kidney disease, the researchers used data from European populations. They applied a technique known as Mendelian randomization, which analyzes genetic data to identify potential causal relationships. This method reduces the impact of confounding factors and helps establish whether genetic susceptibility to celiac disease might lead to an increased risk of kidney-related issues. Specifically, they looked at 10 different kidney traits, such as immunoglobulin A nephropathy (a kidney disorder involving deposits in the kidneys), chronic glomerulonephritis (a condition where the kidney’s filtering units become inflamed), and a decline in estimated glomerular filtration rate, which measures kidney function. Key Findings: Increased Risk of Kidney Disease The study found that individuals with a genetic predisposition to celiac disease have a higher risk of developing certain kidney diseases. The data showed a significant increase in the risk of immunoglobulin A nephropathy, with a 44% higher likelihood for those genetically inclined toward celiac disease. Additionally, the study noted a 15% increased risk of chronic glomerulonephritis. A decline in kidney function, as measured by a decrease in the estimated glomerular filtration rate, was also observed. Interestingly, the study also hinted at a potential connection between celiac disease and membranous nephropathy, a type of kidney disease where the immune system attacks the membranes in the kidneys. Although this relationship was not as strong as others, it remains a possibility that requires further investigation. Mechanisms: How Celiac Disease Might Affect the Kidneys One proposed mechanism for this connection is that in individuals with celiac disease, gluten triggers an immune response that does not remain confined to the gut. Instead, this response may cross-react with other tissues, including the kidneys. Specifically, circulating antibodies, which are produced in response to gluten, may end up targeting kidney tissues. These immune reactions and the associated inflammation could damage the kidneys over time, leading to the development of kidney disease. In particular, the study draws attention to the similarity between the damage caused to the intestinal barrier in celiac disease and the type of damage seen in certain kidney diseases, such as immunoglobulin A nephropathy. Some research has shown that antibodies produced in response to gluten can be found in the kidneys of people with this condition, which strengthens the idea that the immune system’s misdirected response in celiac disease can have broader consequences for other organs. Contradictory Evidence: No Clear Link with All Kidney Conditions While the study highlights the increased risk for certain kidney conditions, it also shows that not all kidney diseases are strongly associated with celiac disease. For instance, the research found no significant correlation between celiac disease and diabetic nephropathy, a type of kidney damage commonly seen in people with diabetes. This suggests that the connection between celiac disease and kidney disease may depend on the specific type of kidney condition in question, and not all kidney issues share the same underlying mechanisms with celiac disease. Implications for Individuals with Celiac Disease For individuals diagnosed with celiac disease, the findings of this study underscore the importance of monitoring kidney health. Although kidney problems may not be a common or immediate concern for all celiac patients, there is enough evidence to suggest that people with this condition should be aware of their potential risk for certain types of kidney disease. Regular screenings, such as urine tests or blood tests to assess kidney function, could help detect any early signs of kidney issues before they progress. Moreover, adopting a strict gluten-free diet remains crucial for people with celiac disease. While this study did not directly address the impact of a gluten-free diet on kidney health, other research has suggested that reducing gluten intake can have a positive effect on various health outcomes in celiac patients. Maintaining a gluten-free diet may help minimize the immune response that could contribute to kidney damage. Valuable Insights into the Relationship Between Celiac Disease and Kidney Health This study adds valuable insight into the relationship between celiac disease and kidney health. By using genetic data, the researchers were able to show that individuals with a genetic predisposition to celiac disease may be at a higher risk of developing certain kidney diseases, such as immunoglobulin A nephropathy and chronic glomerulonephritis. While not all kidney diseases are linked to celiac disease, the findings highlight the need for continued research into how autoimmune responses triggered by gluten can affect other organs beyond the gut. For those with celiac disease, understanding this potential link to kidney health could help improve long-term outcomes through early detection and prevention. If future research confirms these findings, routine kidney screenings could become an important part of managing celiac disease, ultimately reducing the risk of serious kidney complications. Read more at: journals.lww.com

Celiac.com 09/05/2023 - Celiac disease is a T-cell-mediated gluten sensitivity that results in villous atrophy in the small intestine, leading to chronic malabsorption. Patients with celiac disease are prone to malnutrition. A team of researchers recently assessed the impact of malnutrition on in-hospital outcomes in patients with celiac disease. This study analyzed data from the National Inpatient Sample Database, encompassed 187,310 patients with celiac disease. The team included patients with a primary discharge diagnosis of celiac disease between January 2016 and December 2019 from the National Inpatient Sample Database. Data included patient demographics, hospital characteristics, the Charlson Comorbidity Index, and concomitant comorbidities. The association between malnutrition and outcomes, including mortality, deep vein thrombosis, pulmonary embolism, sepsis, acute kidney injury, length of stay, and total hospitalization charges, was analyzed using the multivariate regression model. Malnutrition Rate Among Hospitalized Celiacs at 8.3% and 108% Increase in Mortality Rate The rate of malnutrition among celiac patients was found to be 8.3%, aligning with similar rates seen in prior research. However, this study adds new insights by demonstrating the link between malnutrition and various detrimental outcomes in hospitalized celiac patients. The research reveals that malnourished celiac patients are at a significantly higher risk of in-hospital mortality and resource utilization, as well as a range of complications including deep vein thrombosis, sepsis, acute kidney injury, and prolonged length of stay. The heightened mortality risk is particularly alarming, with a staggering 108% increase in mortality rates observed in malnourished celiac patients. The complex pathophysiology behind malnutrition in celiac disease involves factors like intestinal damage-induced malabsorption and chronic diarrhea. Common nutritional deficiencies in celiac patients encompass iron, zinc, folic acid, vitamin B12, vitamin D, and calcium. Despite these challenges, many celiac patients display malnutrition-related symptoms. Malnutrition was also associated with an increased risk of deep vein thrombosis, suggesting that diet could influence thrombosis-related factors. Additionally, acute kidney injury was more likely to develop in malnourished celiac patients, possibly due to dehydration and reduced serum creatinine levels. Sepsis, a serious condition, was found to be 43% more likely in patients with malnutrition, linked to their lower immunity caused by inadequate dietary intake. The study underscores the significance of proper nutrition in celiac patients, both for mitigating immediate complications and preventing long-term adverse effects. However, the study's limitations highlight the need for further investigation into factors such as disease severity, pharmaceutical therapies, and treatment compliance. The findings emphasize the importance of a multidisciplinary approach to manage malnutrition in celiac patients, involving nutritional screening, medical therapy, and dietary recommendations, as well as interventions like enteral or parenteral nutrition. Lastly, the research highlights the need for further investigations into factors contributing to malnutrition in celiac disease, and the effectiveness of interventions to address it. Read more in cureus.com The researchers included Kanwal Bains, Shivam Kalra, Ishandeep Singh, Jay Patel, Isha Kohli, Mukul Dhiman, Dino Dukovic, Aalam Sohal, and Avin Aggarwal. They are variously affiliated with the department of Internal Medicine, University of Arizona College of Medicine, Tucson, USA; the department of Internal Medicine, Trident Medical Center in North Charleston, USA; the department of Internal Medicine, Dayanand Medical College and Hospital in Punjab, IND; the Digestive Disease and Surgical Institute, Cleveland Clinic in Cleveland, USA; the department of Public Health Sciences, Icahn School of Medicine at Mount Sinai in New York , USA; the Internal Medicine, Punjab Institute of Medical Sciences in Punjab, IND; the department of Internal Medicine, Ross University School of Medicine in Bridgetown, BRB; and the department of Internal Medicine, UCSF Fresno in Fresno, USA.