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- Title
NEPREPOZNATA CELIJAKIJA U BOLESNIKA S BUBREŽNIM TRANSPLANTATOM - PRIKAZ SLUČAJA I PREGLED LITERATURE.
- Authors
MIKOLAŠEVIĆ, IVANA; LUKENDA, VESNA; ORLIĆ, LIDIJA; SLADOJE-MARTINOVIĆ, BRANKA; VUKSANOVIĆ-MIKULIČIĆ, SRETENKA; ANIĆ, KATA; MAVRINAC, VOJKO; JAKOPČIĆ, IVAN; KRBAVAC, DRAGANA; RAČKI, SANJIN
- Abstract
Both new and conventional immunosuppressive drugs are able to provide excellent patient and organ survival rates following kidney transplantation. Thus, in addition to short- and long-term efficacy, treatment choice is becoming more dependent upon other factors such as the adverse events. Gastrointestinal adverse events (infections [bacterial, viral, fungal], abdominal pain, nausea/vomiting, dyspepsia and diarrhea) are common in transplant recipients, with one of the most frequent being diarrhea. Celiac disease (CD) is a frequent chronic autoimmune disease affecting approximately 1% of the population in the Western hemisphere. It is characterized by an abnormal response to gluten in genetically predisposed individuals. The disease has various clinical manifestations and serious complications can occur if left untreated. It can develop at any point in time during life. Patients with CD may present to specialists other than gastroenterologists with diverse clinical manifestations. Gastroenterologists are already familiar with the association between CD and immune and non-immune diseases. However, many diseases outside of the digestive system are also linked with CD, and patients with CD have about a ten-fold greater risk of other autoimmune diseases than the general population. Here we report case of a 56-year-old patient referred to our centre because of diarrhoea, who had a kidney transplant since 2007. Since transplantation, he had no acute rejection crisis or infections. But, during the last three years he was hospitalized at our Department for several times due to diarrhoea, wight losses and worsening of the kidney function. There were no signs of infections or malignant. In May 2010, a patients was admitted to our department after one more episode of diarrhoea and weight loss that had occurred during the past 14 days. During that hospitalisations screening evaluations for infection etiologies of diarrhoea was unremakable. Anti-tTG antibodies were within normal range. He had disturbances of consciousness and hallucinations. A CT of brain was without any abnormalities. A gastroscopy together with multiple duodenal biopsies was performed. Histological findings were compatible with a coeliac disease. According to the Marshal classification grade 3A. The patient was advised to follow gluten free diet and was started on an enteral and parenteral nutrition because of malnutrition. The patient reponded weel. Continued further ambulatory monitoring by a nephrologist and gastroenterologist was advised. Patients with CD may present to specialists other than gastroenterologists with diverse clinical manifestations. We would like to stress the necessity of an interdisciplinary approach to patients with CD as well as many otherconditions.
- Publication
Acta Medica Croatica, 2014, Vol 68, p180
- ISSN
1330-0164
- Publication type
Case Study