Abstract
Recent data link a dysregulated ‘gut-kidney axis’ to the development of immunoglobulin A nephropathy (IgAN), which may set the stage for more specific therapeutic approaches. Here, we aimed to analyze whether IgAN patients have a disturbed intestinal barrier function. We conducted an observational, single-center study to assess gut permeability in 35 IgAN patients, 18 patients with other glomerular diseases and 19 controls. Baseline characteristics are displayed in table 1. After an overnight fast, trial participants ingested a multi-sugar solution (lactulose, L-rhamnose, sucralose and erythritol). Subsequently, urine was collected over a period of 0-2h, 2-5h, 5-24h post-administration. Quantification of the sugars was carried out using isocratic ion-exchange high performance liquid chromatography mass spectrometry. Markers of small-intestine (lactulose/rhamnose (L/R) ratio, 0-2h and sucralose/erythritol (S/E) ratio 2-5h post-administration) and colon permeability (sucralose/erythritol (S/E) ratio, 5-24h post-administration) were calculated and compared between groups. Patients with glomerular diseases displayed an increased small intestine permeability (L/R, 0-2h) compared to control individuals (p=0.008), yet this difference was only significant in patients with non-IgAN glomerulopathies and IgAN patients only exhibited a trend towards an elevated small intestinal permeability (Figure 1A/B). Furthermore, we observed a decreased excretion of sucralose (p<0.05) in IgAN patients after 24h. Yet, the S/E ratio over the 5-24h-period that reflects colon permeability only showed a trend towards a decreased ratio in these patients (Figure 1C). Neither the degree of proteinuria nor eGFR correlated with small intestinal or colon permeability ratios in the two patient groups. The present study suggests a disturbed intestinal permeability is common in patients with glomerular diseases and does not specifically occur in IgAN.
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