Minimal change disease in association with celiac disease; a case report and review of the literature

Abstract

Celiac disease may be associated with a variety of autoimmune diseases such as type 1 diabetes, autoimmune thyroid disorders, Sjogren’s syndrome and untypically with renal diseases such as nephrotic syndrome. These associations have been reported in nephrotic syndrome cases secondary to IgA nephropathy, membranoproliferative glomerulonephritis, membranous glomerulopathy and minimal change disease. Minimal change disease is a major cause of idiopathic nephrotic syndrome, characterized by intense proteinuria leading to edema and intravascular volume depletion. In adults, it is responsible for approximately one sixth of idiopathic nephrotic syndrome cases, whereas it stands for a much higher percentage at younger ages, for example it accounts for up to two thirds in children with an age less than two years old. The coexistence of celiac disease and nephrotic syndrome is extremely rare. Only a few cases have been reported in the corresponding medical literature so far, with both celiac disease and minimal change disease. Since the prevalence of celiac disease is overall 1%, the question arises whether the coexistence of celiac disease and minimal change disease is just a coincidence or not. As they both are immune mediated diseases, a link between them is reasonable. We are going to report a 46-year-old man who was admitted with both nephrotic syndrome (with proteinuria of 4.5 g/d) and probable mal-absorption syndrome, causing an iron deficiency anemia and weight loss. Clinically, he was diagnosed with celiac disease and minimal change disease, which was confirmed, by both small bowel and kidney biopsy. Renal biopsy showed minimal change disease and diffuse podocyte damage. The patient was treated with a gluten free diet and immunosuppressive therapy with corticosteroids, initially, followed by cyclosporine. Unfortunately, the treatment was not completely successful and later he developed chronic kidney injury that required hemodialysis for several years.

Keywords: Chronic kidney disease, Celiac disease, Minimal change disease, Nephrotic syndrome, Hemodialysis