Kidney Week

Abstract: TH-PO732

Tick-Borne Disease and Kidney

Session Information

• Glomerular Diseases: Case Reports
  November 02, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Glomerular Diseases

• 1402 Glomerular Diseases: Clinical, Outcomes, and Trials

Authors

• Kaur, Ramandeep, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire, United States

Ramandeep Kaur,

• Choudhury, Mushfique, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire, United States

Mushfique Choudhury,

• Pettus, Jason R., Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire, United States

Jason R. Pettus,

• Kaneko, Thomas M., Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire, United States

Thomas M. Kaneko,

• Block, Clay A., Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire, United States

Clay A. Block,

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