Title: Unraveling the role of early coeliac disease diagnosis in the risk of developing immune-
mediated renal diseases
Version: 1 Date: 23 Mar 2024
Reviewer:  Kamran Rostami
Reviewer's report:
This is an interesting study well written, conducted by Francesco De Luca et al that quantify the
risk of developing immune-mediated renal diseases (IMRDs) in coeliac patients.
I would like to thank the authors as this study would be a great addition to the current literature
emphasising the protective and preventive  role of gluten free diet.
The authors used the  data from the Swedish national patient register. The association
was assessed retrospectively  before or after coeliac disease diagnosis. The study suggest
unrecognized CD patients had a higher risk to develop  IMRDs and gluten free diet as we
know is protective as the risk of IMRDs was reduced post diagnosis.  Another interesting
finding of this study was increased IMRDs prevalence with age. This finding may suggest
that unrecognised CD with long-term gluten exposure is significant risk factors for developing
IMRDs and other autoimmune disorders. Alternatively and most likely explanation would be
genuine predisposition for autoimmune conditions in CD.  It might be difficult to estimate
if gluten free diet can be more protective and preventive in those older patients who were
promptly diagnosed and treated for CD? I acknowledge this was one of the limitation of the
study, but still the authors may discuss briefly some possible explanation for their age related
risk stratification like what they mentioned in Background (We also expected to find that longer
duration of persistent exposure to gluten increases the risk of developing IMRDs) The current
literature suggest the prevalence of Autoimmune Disorders rises with the age in non-coeliac
relatives of CD patients as they share similar  genetic susceptibility in association with, similar
environmental triggering factors.
Minor comments
Background line 79 page 4 the hypothesis may need to be moved to discussion alongside the
rest: We also expected to find that longer duration of persistent exposure to gluten increases the
risk of developing IMRDs
Title: Unraveling the role of early coeliac disease diagnosis in the risk of developing immune-
mediated renal diseases
Version: 1 Date: 23 Mar 2024
Reviewer:  Kamran Rostami
Reviewer's report:
This is an interesting study well written, conducted by Francesco De Luca et al that quantify the
risk of developing immune-mediated renal diseases (IMRDs) in coeliac patients.
I would like to thank the authors as this study would be a great addition to the current literature
emphasising the protective and preventive  role of gluten free diet.
The authors used the  data from the Swedish national patient register. The association
was assessed retrospectively  before or after coeliac disease diagnosis. The study suggest
unrecognized CD patients had a higher risk to develop  IMRDs and gluten free diet as we
know is protective as the risk of IMRDs was reduced post diagnosis.  Another interesting
finding of this study was increased IMRDs prevalence with age. This finding may suggest
that unrecognised CD with long-term gluten exposure is significant risk factors for developing
IMRDs and other autoimmune disorders. Alternatively and most likely explanation would be
genuine predisposition for autoimmune conditions in CD.  It might be difficult to estimate
if gluten free diet can be more protective and preventive in those older patients who were
promptly diagnosed and treated for CD? I acknowledge this was one of the limitation of the
study, but still the authors may discuss briefly some possible explanation for their age related
risk stratification like what they mentioned in Background (We also expected to find that longer
duration of persistent exposure to gluten increases the risk of developing IMRDs) The current
literature suggest the prevalence of Autoimmune Disorders rises with the age in non-coeliac
relatives of CD patients as they share similar  genetic susceptibility in association with, similar
environmental triggering factors.
Minor comments
Background line 79 page 4 the hypothesis may need to be moved to discussion alongside the
rest: We also expected to find that longer duration of persistent exposure to gluten increases the
risk of developing IMRDs
Please review this paper.
user
Title: Unraveling the role of early coeliac disease diagnosis in the risk of developing immune-
mediated renal diseases
Version: 1 Date: 23 Mar 2024
Reviewer:  Kamran Rostami
Reviewer's report:
This is an interesting study well written, conducted by Francesco De Luca et al that quantify the
risk of developing immune-mediated renal diseases (IMRDs) in coeliac patients.
I would like to thank the authors as this study would be a great addition to the current literature
emphasising the protective and preventive  role of gluten free diet.
The authors used the  data from the Swedish national patient register. The association
was assessed retrospectively  before or after coeliac disease diagnosis. The study suggest
unrecognized CD patients had a higher risk to develop  IMRDs and gluten free diet as we
know is protective as the risk of IMRDs was reduced post diagnosis.  Another interesting
finding of this study was increased IMRDs prevalence with age. This finding may suggest
that unrecognised CD with long-term gluten exposure is significant risk factors for developing
IMRDs and other autoimmune disorders. Alternatively and most likely explanation would be
genuine predisposition for autoimmune conditions in CD.  It might be difficult to estimate
if gluten free diet can be more protective and preventive in those older patients who were
promptly diagnosed and treated for CD? I acknowledge this was one of the limitation of the
study, but still the authors may discuss briefly some possible explanation for their age related
risk stratification like what they mentioned in Background (We also expected to find that longer
duration of persistent exposure to gluten increases the risk of developing IMRDs) The current
literature suggest the prevalence of Autoimmune Disorders rises with the age in non-coeliac
relatives of CD patients as they share similar  genetic susceptibility in association with, similar
environmental triggering factors.
Minor comments
Background line 79 page 4 the hypothesis may need to be moved to discussion alongside the
rest: We also expected to find that longer duration of persistent exposure to gluten increases the
risk of developing IMRDs
assistant