Download citation file:
Today, Lyme disease is the most common vector-borne disease in the US, with over 22 500 confirmed cases in 2010. Borrelia burgdorferi, a spirochete, is transmitted by the bite of infected Ixodes ticks. These ticks have a 3-stage lifecycle (larvae, nymph, and adult) and take 1 blood meal at each stage. They become infected by feeding on an infected wild animal—typically white-footed mice, voles, chipmunks, or birds—during the larval feeding. The infection is maintained during the tick molting process to the nymphal stage and can be transmitted to other animals to maintain the cycle of infection in the wild. Both nymphal and adult Ixodes ticks can transmit infection to humans.
Please read the other comments before posting. Contributors must reveal any conflict
Comments are moderated and will appear on the site at the discretion of The American
College of Physicians editorial staff. Please be sure your email address is
updated in your account, otherwise the American College of Physicians will not be
able to contact you about your comment.
* = Required Field
Disclosure of Any Conflicts of Interest*
(applies to the past 5 years and foreseeable future) Indicate any potential conflicts
of interest of each author below, including specific financial interests and relationships
and affiliations relevant to the subject matter or materials discussed in the manuscript
(eg, employment/affiliation, grants or funding, consultancies, honoraria, speakers
bureau, stock ownership or options, expert testimony, royalties, donation of medical
equipment, or patents filed, received, or pending). If all authors have none, check
"No potential conflicts or relevant financial interests" in the box below. Please
also indicate any funding received in support of this work. The information will
be posted with your response.
We have read the interesting review on Lyme disease by Linden Hu . As long as clinical presentation of the disease is actually protean and the disease is endemic in certain areas of the world, a thorough knowledge of its clinical presentation will help health professionals acquire high clinical suspicion for the disease. Following earlier similar reports in animals [2,3], we and others have reported several cases of Lyme-associated, apparently immune complex-mediated glomerulonephritis, often of the membranoproliferative type, manifested either as a nephritic, or nephrotic syndrome or even as acute renal failure of various gravity [4-8]. It is now seems possible that this has been an unreckognized, and still remains a rather under-reckognized condition  by primary care physicians as well as nephrologists and, as such, it often evades diagnosis or is mis-diagnosed as “primary” glomerulonephritis. In this context, it would seem appropriate that “Lyme-nephritis” is included into the clinical presentation of Lyme disease in the literature as well as in physicians’ diagnostic arsenal.
1.Hu LT. Lyme disease. Ann Intern Med 2012; 157(3):ITC2-1.
2.Dambach DM, Smith CA, Lewis RM, Van Winkle TJ: Morphologic, immunohistochemical, and ultrastructural characterization of a distinctive renal lesion in dogs putatively associated with Borrelia burgdorferi infection: 49 Cases (1987-1992). Vet Pathol 1997; 34: 85-96.
3.Grauer GF, Burgess EC, Cooley AJ, Hagee JH: Renal lesions associated with Borrelia burgdorferi infection in a dog. JAm Vet Med Assoc 1988; 193:237-9.
4.Kelly B, Finnegan P, Cormican M, et al. Lyme disease and glomerulonephritis. Ir Med J 1999; 92: 372-3.
5.Kirmizis D, Efstratiadis G, Economidou D et al. MPGN secondary to Lyme disease. Am J Kidney Dis 2004; 43: 544–51.
6.Papineni P, Doherty T, Pickett T, et al. Membranous glomerulonephritis secondary to Borrelia burgdorferi infection presenting as nephrotic syndrome. NDT Plus 2010; 3: 105-6.
7.Mc Causland FR, Niedermaier S, Bijo V, Rennke HG, Choi ME, Forman JP.
8.Kwiatkowska E, Gołembiewska E, Ciechanowski K, Kędzierska K. Minimal-Change Disease Secondary to Borrelia burgdorferi Infection. Case Reports in Nephrology 2012; doi:10.1155/2012/294532
9.Kirmizis D, Chatzidimitriou D. Comment on 'Membranous glomerulonephritis secondary to Borrelia burgdorferi infection presenting as nephrotic syndrome'. Nephrol Dial Transplant. 2010; 25: 1723-7.
Clinical Slide Set. Lyme Disease
The In the Clinic® slide sets are owned and copyrighted by the American College
of Physicians (ACP). All text, graphics, trademarks, and other intellectual property
incorporated into the slide sets remain the sole and exclusive property of the ACP.
The slide sets may be used only by the person who downloads or purchases them and
only for the purpose of presenting them during not-for-profit educational activities.
Users may incorporate the entire slide set or selected individual slides into their
own teaching presentations but may not alter the content of the slides in any way
or remove the ACP copyright notice. Users may make print copies for use as hand-outs
for the audience the user is personally addressing but may not otherwise reproduce
or distribute the slides by any means or media, including but not limited to sending
them as e-mail attachments, posting them on Internet or Intranet sites, publishing
them in meeting proceedings, or making them available for sale or distribution in
any unauthorized form, without the express written permission of the ACP. Unauthorized
use of the In the Clinic slide sets will constitute copyright infringement.
to gain full access to the content and tools.
Learn more about subscription options