A prognostic model for the determination of serological markers of celiac disease in patients with IgA nephropathy

IgA nephropathy (IgA-H) is the most common form of chronic glomerulonephritis. The results of previously conducted experimental and clinical studies suggest the existence of a potential pathogenetic enterorenal axis mediating the development of IgA-H, where diseases accompanied by clinically obvious or subclinical intestinal infl ammation play a leading role. Since widespread screening for celiac disease (CD) in patients with IgA-H is not provided, a universal tool is needed to help the doctor determine the need for additional examination, which ultimately expands treatment options. Objectivе. To develop a prognostic model to determine the probability of detecting serological markers of CD in blood serum in patients with IgA-H. Material and methods. The study included 92 patients aged 18 to 63 years with morphologically confi rmed IgA-H. The average age (M ± SD) was 34.66 ± 9.28 years. Gender distribution: men — 87 (94.6%), women — 5 (5.4%). The median duration of the disease before diagnosis of IgA-H by renal biopsy was 20 (8–48) months. All patients underwent a comprehensive examination, including serological markers of CD in the blood serum. Based on the data obtained by binary logistic regression, a prognostic model for determining the probability of serological markers of CD in patients with IgA-H depending on proteinuria, systolic blood pressure and IgA was constructed. Results. The obtained regression model turned out to be statistically signifi cant (p < 0.001). The area under the ROC curve was 0.872 ± 0.053 with 95% CI: 0.768–0.976 (p < 0.001). The sensitivity and specifi city of the model were 85.0% and 91.7%, respectively. Conclusion. The obtained prognostic model can help clinicians to select patients with IgA-H for screening for the presence of CD. As a result, the possibilities of therapy in the form of rationaladministration of an aglutene diet in combination with nephroprotective therapy with ACE/ARB will be expanded, which will increase the eff ectiveness of treatment and improve the prognosis.

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