Can Lyme Disease Affect the Kidneys? Case Reports and Clinical Insights
Quick Answer: Lyme disease can affect the kidneys in rare cases, typically through immune-mediated mechanisms rather than direct infection.
Clinical Insight: Kidney involvement in Lyme disease is uncommon but may occur as part of a broader inflammatory response affecting multiple systems.
Can Lyme disease cause kidney problems?
In most cases, Lyme disease affects the skin, joints, nervous system, and heart. However, rare reports show that it may also involve the kidneys.
These cases suggest that immune system activation—not just infection—may play a role in kidney complications.
Case 1: Immune-Mediated Kidney Inflammation
A 57-year-old woman presented with shortness of breath after several weeks of symptoms including nausea, fatigue, headache, and muscle aches. She later developed a rash on her shoulder.
She was diagnosed with Lyme disease and initially treated with doxycycline, then switched to intravenous ceftriaxone due to concern for disseminated infection.
A kidney biopsy revealed:
- Global hypercellularity
- Mesangial expansion
- Subendothelial immune deposits
These findings were consistent with immune complex-mediated membranoproliferative glomerulonephritis.
The patient improved with a combination of antibiotics and steroids.
The authors concluded that the clinical course and response to treatment were consistent with a Lyme-associated immune-mediated kidney condition.
Case 2: Lyme Disease Triggering Kidney Disease Flare
A 40-year-old man presented with visible blood in his urine one week after a tick bite.
He developed symptoms including:
- Fever
- Headache
- Muscle aches
- Sore throat
Kidney evaluation revealed:
- Dysmorphic red blood cells
- Red cell casts
- IgA nephropathy on biopsy
This suggested that Lyme disease may have triggered a flare of a previously silent kidney condition.
During treatment, the patient developed a rash and tested positive for Lyme disease.
He was treated with doxycycline and steroids, with improvement.
How Lyme Disease May Affect the Kidneys
These cases suggest two possible mechanisms:
- Immune complex deposition causing kidney inflammation
- Activation of underlying kidney disease through immune response
In both scenarios, the immune system plays a central role.
This reflects broader patterns seen in persistent infection and immune dysfunction.
Why Kidney Involvement Is Often Missed
Kidney complications are rare and not typically associated with Lyme disease.
This can lead to delayed recognition, especially when symptoms involve multiple systems.
As with other atypical presentations, diagnosis may depend on recognizing patterns across systems rather than focusing on a single organ.
See how this contributes to delayed Lyme disease diagnosis.
Clinical Takeaway
Lyme disease can, in rare cases, be associated with kidney involvement.
These cases suggest that immune-mediated mechanisms may contribute to kidney inflammation or trigger existing disease.
When patients present with systemic symptoms and unexplained kidney findings, Lyme disease may be considered—particularly in endemic areas.
Related Articles
- Kidney failure associated with Lyme disease
- Recognizing Lyme disease in patients with kidney disease
References
- Mc Causland FR et al. Lyme disease-associated glomerulonephritis. Nephrol Dial Transplant. 2011.
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
