Gut permeability to small molecules was assessed by the differential absorption of cellobiose and mannitolin 18 patients with IgA nephropathy (IgAN). The urinary cellobiose:mannitol excretion ratio in patients did not differ (P = 0.42) from controls. These findings do not support the hypothesis that chronic increased mucosal permeability allows excessive antigen penetration to the mucosal immune system, predisposing to glomerular IgA deposition in IgA nephropathy. However, the patient with the greatest cellobiose:mannitol ratio developed macroscopic haematuria within 3 weeks of testing, raising the possibility of a transient abnormality in gut permeability.
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