Reviewer ’s report  
 
Title: Case report on pathogenetic link between gluten and IgA nephropathy  
 
Version: 0 Date: 21 Nov 2017  
 
Reviewer: Karn Wijarnpreecha  
 
Reviewer's report:  
 
It was my pleasure to review the manuscript from Costa and colleagues. This is an interesting 
case reporting the pathogenesis link between Celiac disease and IgA nephropathy. However, I 
have few comments:  
1. Is it strong enough to diagnose celiac disease with only the presence of anti -tTG2 deposit in 
the intestine without presence of duodenal atrophy or positive celiac serology especially in 
this patient with cystic fibrosis which has been shown to be associated with IgA 
nephropathy ? (PMID: 12297060, 10203000, 17598378).  
 
2. What is the sensitivity and specificity of anti -tTG2 in the diagnosis of Celiac disease with no 
symptoms/villous atrophy? Anti -tTG2 staining is not a reliable marker for the diagnosis of 
Celiac disease according to the recent study from Das et al 2016 (PMID: 27753658). I doubt 
that this patient may not truly have celiac disease and the assumption of the association 
between IgA nephropathy and celiac disease may be weak.  
 
3. How do you explain that IgA nephropathy in this case is not associated or caused by the 
cystic fibrosis?  
 
4. What is the consequence after started patient on the gluten free diet? Is gluten free diet 
improving duodenal damage as well as IgA nephropathy?  
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
Yes 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
Unable to assess  
 
  
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
Yes 
 
Are you able to assess any statistics in the manuscript or would you recommend an  
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects requ ire further  
assessment in your comments to the editors.  
 
Not relevant to this manuscript  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Needs some language correctio ns before being published  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years received reimbursements, fees, funding, or salary from an  
organisation that may in any way gain or lose financially from the publication of this  
manuscript, either  now or in the future?  
 
2. Do you hold any stocks or shares in an organisation that may in any way gain or lose  
financially from the publication of this manuscript, either now or in the future?  
 
3. Do you hold or are you currently applying for any patents re lating to the content of the  
manuscript?  
 
4. Have you received reimbursements, fees, funding, or salary from an organization that 
holds  or has applied for patents relating to the content of the manuscript?  
 
5. Do you have any other financial competing intere sts? 
 
6. Do you have any non -financial competing interests in relation to this paper?  
 
If you can answer no to all of the above, write 'I declare that I have no competing interests' 
below.  If your reply is yes to any, please give details below.  
 
I declare that I have no competing interests.  
 
I agree to the open peer review policy of the journal. I understand that my name will be included  
on my report to the authors and, if the manuscript is accepted for publication, my named report  
including any at tachments I upload will be posted on the website along with the authors'  
responses.  I agree for my report to be made available under an Open Access Creative Commons 
CC-BY license ( http://creativecommons.org/licenses/by/4.0/ ). I understand that any comments  
which I do  not wish to be included in my named report can be included as confidential comments 
to the  editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
Reviewer ’s report  
 
Title: Case report on pathogenetic link between gluten and IgA nephropathy  
 
Version: 0 Date: 21 Nov 2017  
 
Reviewer: Karn Wijarnpreecha  
 
Reviewer's report:  
 
It was my pleasure to review the manuscript from Costa and colleagues. This is an interesting 
case reporting the pathogenesis link between Celiac disease and IgA nephropathy. However, I 
have few comments:  
1. Is it strong enough to diagnose celiac disease with only the presence of anti -tTG2 deposit in 
the intestine without presence of duodenal atrophy or positive celiac serology especially in 
this patient with cystic fibrosis which has been shown to be associated with IgA 
nephropathy ? (PMID: 12297060, 10203000, 17598378).  
 
2. What is the sensitivity and specificity of anti -tTG2 in the diagnosis of Celiac disease with no 
symptoms/villous atrophy? Anti -tTG2 staining is not a reliable marker for the diagnosis of 
Celiac disease according to the recent study from Das et al 2016 (PMID: 27753658). I doubt 
that this patient may not truly have celiac disease and the assumption of the association 
between IgA nephropathy and celiac disease may be weak.  
 
3. How do you explain that IgA nephropathy in this case is not associated or caused by the 
cystic fibrosis?  
 
4. What is the consequence after started patient on the gluten free diet? Is gluten free diet 
improving duodenal damage as well as IgA nephropathy?  
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
Yes 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
Unable to assess  
 
  
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
Yes 
 
Are you able to assess any statistics in the manuscript or would you recommend an  
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects requ ire further  
assessment in your comments to the editors.  
 
Not relevant to this manuscript  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Needs some language correctio ns before being published  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years received reimbursements, fees, funding, or salary from an  
organisation that may in any way gain or lose financially from the publication of this  
manuscript, either  now or in the future?  
 
2. Do you hold any stocks or shares in an organisation that may in any way gain or lose  
financially from the publication of this manuscript, either now or in the future?  
 
3. Do you hold or are you currently applying for any patents re lating to the content of the  
manuscript?  
 
4. Have you received reimbursements, fees, funding, or salary from an organization that 
holds  or has applied for patents relating to the content of the manuscript?  
 
5. Do you have any other financial competing intere sts? 
 
6. Do you have any non -financial competing interests in relation to this paper?  
 
If you can answer no to all of the above, write 'I declare that I have no competing interests' 
below.  If your reply is yes to any, please give details below.  
 
I declare that I have no competing interests.  
 
I agree to the open peer review policy of the journal. I understand that my name will be included  
on my report to the authors and, if the manuscript is accepted for publication, my named report  
including any at tachments I upload will be posted on the website along with the authors'  
responses.  I agree for my report to be made available under an Open Access Creative Commons 
CC-BY license ( http://creativecommons.org/licenses/by/4.0/ ). I understand that any comments  
which I do  not wish to be included in my named report can be included as confidential comments 
to the  editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
Please review this paper.
user
Reviewer ’s report  
 
Title: Case report on pathogenetic link between gluten and IgA nephropathy  
 
Version: 0 Date: 21 Nov 2017  
 
Reviewer: Karn Wijarnpreecha  
 
Reviewer's report:  
 
It was my pleasure to review the manuscript from Costa and colleagues. This is an interesting 
case reporting the pathogenesis link between Celiac disease and IgA nephropathy. However, I 
have few comments:  
1. Is it strong enough to diagnose celiac disease with only the presence of anti -tTG2 deposit in 
the intestine without presence of duodenal atrophy or positive celiac serology especially in 
this patient with cystic fibrosis which has been shown to be associated with IgA 
nephropathy ? (PMID: 12297060, 10203000, 17598378).  
 
2. What is the sensitivity and specificity of anti -tTG2 in the diagnosis of Celiac disease with no 
symptoms/villous atrophy? Anti -tTG2 staining is not a reliable marker for the diagnosis of 
Celiac disease according to the recent study from Das et al 2016 (PMID: 27753658). I doubt 
that this patient may not truly have celiac disease and the assumption of the association 
between IgA nephropathy and celiac disease may be weak.  
 
3. How do you explain that IgA nephropathy in this case is not associated or caused by the 
cystic fibrosis?  
 
4. What is the consequence after started patient on the gluten free diet? Is gluten free diet 
improving duodenal damage as well as IgA nephropathy?  
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
Yes 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
Unable to assess  
 
  
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
Yes 
 
Are you able to assess any statistics in the manuscript or would you recommend an  
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects requ ire further  
assessment in your comments to the editors.  
 
Not relevant to this manuscript  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Needs some language correctio ns before being published  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years received reimbursements, fees, funding, or salary from an  
organisation that may in any way gain or lose financially from the publication of this  
manuscript, either  now or in the future?  
 
2. Do you hold any stocks or shares in an organisation that may in any way gain or lose  
financially from the publication of this manuscript, either now or in the future?  
 
3. Do you hold or are you currently applying for any patents re lating to the content of the  
manuscript?  
 
4. Have you received reimbursements, fees, funding, or salary from an organization that 
holds  or has applied for patents relating to the content of the manuscript?  
 
5. Do you have any other financial competing intere sts? 
 
6. Do you have any non -financial competing interests in relation to this paper?  
 
If you can answer no to all of the above, write 'I declare that I have no competing interests' 
below.  If your reply is yes to any, please give details below.  
 
I declare that I have no competing interests.  
 
I agree to the open peer review policy of the journal. I understand that my name will be included  
on my report to the authors and, if the manuscript is accepted for publication, my named report  
including any at tachments I upload will be posted on the website along with the authors'  
responses.  I agree for my report to be made available under an Open Access Creative Commons 
CC-BY license ( http://creativecommons.org/licenses/by/4.0/ ). I understand that any comments  
which I do  not wish to be included in my named report can be included as confidential comments 
to the  editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
assistant