Lyme Disease Kidney Failure: A Rare but Serious Complication
Kidney failure is a rare complication of Lyme disease.
Disseminated infection may involve multiple organ systems.
Delayed treatment can increase the risk of severe illness.
Hello, and welcome to another Inside Lyme Podcast. I am your host Dr. Daniel Cameron.
In this episode, I discuss the case of a 66-year-old woman who ignored a bull’s-eye rash suggestive of Lyme disease and later developed acute renal failure, also referred to as kidney failure
Mishra and colleagues described this case, entitled “Disseminated Erythema Migrans,” in the American Journal of Medicine. [1]
Case Report: Kidney Failure and Disseminated Lyme Disease
Over a two-week period, a 66-year-old woman with a history of obesity, hypertension, and hyperlipidemia developed fever and malaise.
One month earlier, she reportedly had a tick bite on her right groin.
“A few days later she noticed a bull’s-eye lesion over the same area which she ignored,” the authors explain.
READ MORE: Doctors Recognize Lyme Disease in a Patient With Kidney Disease
Delayed recognition of erythema migrans remains one of the most common reasons early Lyme disease progresses before treatment begins.
The woman developed findings consistent with disseminated Lyme disease. She had “high grade, intermittent fever, malaise, and fatigability,” along with “multiple, painless, red color skin lesions involving her arms, legs and lower back,” the authors write.
Early disseminated Lyme disease typically occurs shortly after a tick bite when the infection has spread throughout the body.
The patient was hospitalized and found to have unexplained acute renal failure with a creatinine of 4.49 mg/dL. Normal levels are generally closer to 1.
Dialysis is typically considered if creatinine levels remain significantly elevated.
The woman’s IgM Western blot test was positive, which is expected in early Lyme disease.
She was treated clinically with IV ceftriaxone and oral doxycycline.
“Her renal functions improved following hydration, antibiotics, and discontinuation of her losartan and non-steroidal anti-inflammatory drugs,” the authors explain.
For broader discussion of disseminated infection and delayed diagnosis, see Lyme Disease Misdiagnosis and Lyme Disease Symptoms Guide.
Podcast Discussion Questions
- What is the importance of the rash in this case?
- When does an EM rash typically appear?
- A rash may fade after a few days. Does this mean Lyme disease is no longer a concern?
- This patient had multiple disseminated rashes. How common is this and what does it indicate?
- Does a rash always appear at the site of the tick bite?
- What is the risk of Lyme disease from a tick?
- What is the risk of Lyme disease once a rash is identified?
- How often are there treatment delays, even when a rash is present?
- What types of treatment delays have you seen?
- What are the consequences of delayed treatment?
- Have you seen kidney failure associated with Lyme disease?
- Could this patient’s hospitalization and kidney failure have been prevented?
- Have you seen kidney failure in dogs associated with Lyme disease?
- Do you feel treatment was appropriate in this case?
- What can we learn from this case?
Frequently Asked Questions
Can Lyme disease cause kidney failure?
Kidney failure is considered a rare complication of Lyme disease in humans, though disseminated infection and severe systemic illness may occasionally involve the kidneys.
What is disseminated Lyme disease?
Disseminated Lyme disease occurs when the infection spreads beyond the initial tick bite site and affects multiple areas of the body.
Can delayed Lyme disease treatment increase complications?
Delayed recognition and treatment may increase the risk of more extensive infection and serious complications in some patients.
Clinical Takeaway
Kidney failure is uncommon in Lyme disease, but this case highlights how delayed recognition of an erythema migrans rash may contribute to more severe disseminated illness.
Early recognition of Lyme disease and prompt treatment remain important in reducing the risk of serious systemic complications.
Related Articles
- Doctors Recognize Lyme Disease in a Patient With Kidney Disease
- Lyme Disease Misdiagnosis
- Lyme Disease Symptoms Guide
References
- Mishra AK, Hashmath Z, Oneyssi I, Bose A. Disseminated erythema migrans. Am J Med. 2020;133(7):e372-e373.
Dr. Daniel Cameron, MD, MPH
Lyme disease clinician with over 30 years of experience and past president of ILADS.
Symptoms • Testing • Coinfections • Recovery • Pediatric • Prevention
I was diagnosed with Neuroboreliosis (northern Germany strain) in 2001, at that time the Bulls eye rash measured 10” in diameter. I was diagnosed 4 month later and treated inadequately. Now I have interstitial lung disease- fibrosis, kidney disease high moderate to severe, intermittent Tacacardia, multiple spinal compression Dx, osteoporosis /penia, hereditary angioedrma type 3, intermittent bowel obstructions w/hospital additions several times a year – with symptoms of Ilius, pancreatic enzyme deficiency, mast cell activation syndrome, multiple CC and one Basel cell cancer, and one episode edema of my airway – ICU for 5 days not responding to standard treatment. I have been fortunate to have excellent MD’s for HAE (UCSD) and fibrotic hypersensitive pneumonitis (UWMC) I believe some of this may be related to LD. I am desperate for help. Here in the beautiful Pacific NW on one will even hear the word “Lyme disease”. I need your help Dr Camron.
Respectfully GK
I have patients with serious underlying issues who happen to have Lyme disease. They have improved somewhat with antibiotics but still need to address the remaining issues withe their specialists.