Doctors recognize Lyme disease in a patient with kidney disease

Kidney disease induced by Borrelia burgdorferi has been commonly reported in dogs but in the literature there are only a few cases of Lyme disease-associated renal damage in humans. In the February 2017 issue of BMC Nephrology, Florens and colleagues discuss the “unique case of minimal change disease (MCD) associated with chronic Lyme borreliosis that resolved completely after treatment with ceftriaxone and corticosteroids.” [1]

 

by Daniel J. Cameron, MD MPH

The article, “Chronic Lyme borreliosis associated with minimal change glomerular disease: a case report,” cites four published papers describing kidney damage in Lyme disease patients. The papers consisted of 4 cases of membranoproliferative glomerulonephritis (MPGN), a case of crescentic and IgA-deposit nephropathy, and a case of membranous nephropathy. [1]

In another case, the authors describe a 65-year-old Caucasian woman admitted for an acute edematous syndrome related to a nephrotic syndrome. She had a history of hypertension, dyslipidemia, and elevated blood pressure of 163/89 mmHg. Laboratory data showed hypoalbuminemia (1,2 g/dl), severe proteinuria (7,03 g/24 h) and a recent decrease of renal function (serum creatinine level increase from 0,84 to 1,3 mg/dl). Renal biopsy showed minimal change glomerular disease (MCD). [1]

Lyme disease was diagnosed based on positive serologic tests and a 2-year history of violaceous skin lesions of the right calf. The lesions were diagnosed as Acrodermatitis chronica atrophicans (ACA) by skin biopsy. ACA is a Lyme disease finding in Europe. The patient recalled a history of a tick bite on the same leg 9 years earlier without a rash or arthritis.

“This patient is the first case of minimal change glomerular disease associated with chronic Lyme borreliosis,” according to Florens from Edouard Herriot Hospital, Lyon, France. The patient’s nephrotic syndrome and MCD resolved with a combination of intravenous ceftriaxone and the steroid prednisolone.

The leg lesions and neuropathic pain, which persisted despite 21 days of ceftriaxone and prednisolone, cleared following a second course of 32 days of IV ceftriaxone therapy along with pregabalin.

Based on their investigations, Florens and colleagues recommend further studies of the association between kidney disease and Lyme disease. “The decrease of proteinuria after ceftriaxone therapy observed in our case suggests a link between MCD and Lyme disease,” according to Florens. “T-cells, podocytes and bacterial wall antigens could be involved.”

This case reminds doctors of the need to recognize Lyme disease in patients with kidney disease even if an association has not been established.

 

References:

  1. Florens N, Lemoine S, Guebre-Egziabher F, Valour F, Kanitakis J, Rabeyrin M, Juillard L: Chronic Lyme borreliosis associated with minimal change glomerular disease: a case report. BMC Nephrol 2017, 18(1):51.


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Kerry Wagner- Lane RPhDr. Daniel CameronJoanne BJoan OBrien-SingerValerie Sharlow Recent comment authors
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Joan OBrien-Singer
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Hello Dr.Cameron I now have cystic kidney disease. The first cysts were discovered when I received my first round of IV rocephin many many years ago. My urologist wasn’t concerned about them and my radiologist followed them annually. I still have some Lyme symptoms from time to time however my LLMD in Florida retired so I haven’t had treatment for chronic Lyme for a long time. My thought is that if there is a connection of kidney disease and Lyme in dogs, it makes sense to me since we are both mammals that there must be a connection. I wonder… Read more »

Joanne B
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Joanne B

I am 64 year old female who has also been been diagnosed with cystic kidney disease; incidental finding of cysts in my kidneys and liver on an abdominal CT for other symptoms. My kidney function labs are WNL. I have had Lyme disease and Babesiois for 24 years but not treated promptly. Seeing geneticist currently to test for genetic mutation for PKD, however there is no one in my family with it now I am curious about the connection with Lyme.

Valerie Sharlow
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Valerie Sharlow

My 54 year old brother was just diagnosed with stage 4 chronic kidney disease in Syracuse, NY. His doctor told him that it was caused by his Lyme disease. He has been healthy his entire life until this past year. He is meeting with a transplant team next week. I hope to donate a kidney to him if at all possible…but i’m worried about his heart.. If the Lyme attacked his kidneys, then it may have done damage to other organs as well.

Alison Pinkston
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Alison Pinkston

Interesting! I was diagnosed with Lyme and chronic kidney disease simultaneously in 2013. No cause for my CKD has been identified (no high blood pressure, diabetes, etc – generally healthy). CKD hasn’t improved with Lyme treatment but hasn’t really worsened either – just high creatinine & low gfr. Lyme symptoms improved greatly but didn’t disapper completely with treatment, CKD has been holding fairly steady – not improved. I now live in an area where Lyme is very rare so just get puzzled looks when I mention it to doctors here – would be interesting and perhaps beneficial to get involved… Read more »

Flow
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Flow

5 years ago I had a Hanta nephritis (with 3,08mg/dl max., the creatinine was a few month later at a normal stage (1,04mg/dl) again) In July this year, I was infected with lyme disease. I had two antibiosis but I still feel bad. I have high blood pressure, creatinine of 1,42mg/dl and proteinuria. But my doctors don’t believe that there is connection between the lyme disease and the renal insufficiency – because there is nothing in to find in the literature. I hope, you can change this. I wish you all the best for your further work. If I can… Read more »

Kerry Wagner- Lane RPh
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Kerry Wagner- Lane RPh

Greetings Flow and all you fellow Lyme Disease sufferers! My heart is breaking as I read your blogs for th he first time! My name is Kerry and I was born with Lyme Disease in 1955 and have survived an onslaught of autoimmune disorders, like ALS and MS as well as Lyme Carditis and now Lyme Nephritis! I am a Pharmacist since 1991 and had a very successful and lucrative career spaning 5 States! I also raised 4 children but one, my oldest daughter-39yrs died of untreated and undiagnosed Lyme Disease as the blind Western Medicine MDS had misdiagnosed her… Read more »

Carol
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Carol

I have had Lyme for about 10+ years my urine infection has got worse. I am in continent. The NHS refuse to treat more than 2 weeks. Nice guidelines talk about chronic rather than re infection. The department of health though it might recognise CE and FDA tests. NHS doctors are still in denial thinking that the illness cures itself. That a resistance occurs. They only treat the condition with oral antibiotics not IV. The Big Tick Project done by Bristol University vet scientists using vets to take radium samples from dogs across the UK has found that they are… Read more »

Deanna Stazinski
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Deanna Stazinski

My son is 8. He had terrible kidney pain a few hours ago. When he was almost 3 yrs old he had severe bladder pain that led him to be hospitalized. Doctors thought it was a brain tumor, extreme pain disorder, Fabry disease…after months in a Chicago hospital, 4 weeks at Mayo, they all gave up. It was lyme disease. He has been on a variety of antibiotics for the past 4 years. I started to take him off about a month ago. Now this pain. I don’t know what to do. I am glad you are puplishing studies about… Read more »

Joe Walton
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My 16 year old daughter who is extremely active in sports has been tested positive for Lonestar Tick Disease. Over the past couple years since her diagnosis, she has recently been experiencing extreme fatigue, been light headed, hot/sweaty, and urinates frequently. We took her to a Cardiologist where she tested positive in a tilt test. The doctor gave her Fludocortisone to try to put a hormone in her body to make her body retain water better but it has not helped. She also was prescribed metoprolol. She has been taking it for two weeks with no improvement. Since there is… Read more »

Sandy Ellis
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Sandy Ellis

I have stage three kidney disease and was positive for lyme disease. I did antibiotics and was tested after treatment with two different labs and still tested positive . I also had colon cancer in 2009.