Acute kidney injury due to Q fever

• Main Author: Fernandes,Ana R
• Publication Date: 2016
• Other Authors: Gouveia,Francisco, Viegas,Márcio S. R., Coelho,Sofia S., Soares,Elsa Q., Luís,Nuno, Natário,Ana S., Barreto,José C.
• Format: Report
• Language: eng
• Source: Repositórios Científicos de Acesso Aberto de Portugal (RCAAP)
• Download full: http://scielo.pt/scielo.php?script=sci_arttext&pid=S0872-01692016000400008
• topic: Coxiella burnetii infection; membranoproliferative glomerulonephritis; acute kidney injury; nephrotic Syndrome

Coxiella burnetii (C. burnetii) causes a zoonotic disease - Q fever. This bacterium is highly resistant to harsh environmental conditions and causes an uncharacteristic clinical syndrome. Q fever may be acute or chronic and renal manifestations of the disease are more common in the chronic forms. It is reported a case of a 83 -year old woman, with previous normal renal function and a medical history of arterial hypertension and osteoarthritis. She presented with leg oedema, acute kidney injury (serum creatinine 4.14 mg/dl), and an urine protein-to-creatinine ratio of 9.14 gr/gr. A diagnosis of acute kidney injury with nephrotic syndrome was admitted. The lab work revealed a decrease in serum complement levels (C3, C4), and elevated serum levels of β2 -microglobulin and IgM anticardiolipin. Renal ultrasound showed bilateral cysts, so a renal biopsy could not be performed. During hospital stay, renal function worsened with oliguria and the patient needed transient haemodialysis. The renal function gradually recovered but the nephrotic syndrome (ratio 18gr/gr) persisted, with a thrombotic complication (deep vein thrombosis and pulmonary emboli). She presented a fever of unknown origin (FUO) and was treated with several antibiotic courses, eventually becoming afebrile. She was discharged with a serum creatinine 0,89mg/dL and a proteinuria of 18g/24H. By then, we had obtained the result of a positive serology for C. burnetii, so doxycycline was started and proteinuria (0,3gr/gr) remitted. Currently, the patient remains with high levels of C. burnetii antibodies and is still under treatment with doxycycline. The authors report a case of acute Q fever manifested by recurrent fever and acute kidney injury with nephrotic syndrome. This case illustrates a rare aetiology of nephrotic syndrome with acute kidney injury