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Kidney Week

Abstract: TH-PO732

Tick-Borne Disease and Kidney

Session Information

Category: Glomerular Diseases

  • 1402 Glomerular Diseases: Clinical, Outcomes, and Trials

Authors

  • Kaur, Ramandeep, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire, United States
  • Choudhury, Mushfique, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire, United States
  • Pettus, Jason R., Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire, United States
  • Kaneko, Thomas M., Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire, United States
  • Block, Clay A., Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire, United States
Introduction

A case of IgA nephropathy presenting coincidentally with Lyme disease.

Case Description

A previously healthy 41-year-old man presented with 5 days of chest pain, fever, erythematous skin rash, myalgias and painless gross hematuria. Laboratory data showed serum creatinine of 1.22 mg/dL (reference range 0.8-1.5) and CRP of 44.4 mg/L (reference range < 4.9). Urine microscopy showed 8 WBC/HPF and 20 RBC/HPF including acanthocytes. Urine protein-creatinine ratio was 0.8. Creatinine kinase, P-ANCA, C-ANCA, MPO Ab, and PR3 Ab were negative. Lyme IgG and IgM were positive and consistent with active infection with B. burgdorferi. A renal biopsy was performed for persistent microscopic hematuria. Light microscopy was normal, but immunoflorescence (IF) showed 4+ mesangial granular staining for IgA, 2+ kappa and 3+ lambda. C1q, IgG, fibrinogen, albumin were negative. Electron microscopy (EM) confirmed electron dense para-mesangial deposits. A diagnosis of IgA nephropathy was made. In addition to Doxycycline, he was treated with steroid taper and lisinopril. One year later, his urine protein-creatinine ratio is <0.1 and CRP is <3.0 mg/L.

Discussion

Lyme Disease can trigger IgA nephropathy and should be considered in tick exposure. Patients presenting with hematuria and/or proteinuria may be tested for acute Lyme disease.

EM

IF-IgA