2026 Volume 59 Issue 7 Pages 442-448
A 45‒year‒old female with no significant medical history presented with complaints of shortness of breath and lower leg edema that began in August and September 202X, respectively, following COVID‒19 infection in July 202X. She was evaluated at a local clinic, where she was found to have anemia (Hb： 6.2 g/dL) and renal dysfunction (serum creatinine： 8.0 mg/dL). In October 202X, she was referred to our hospital. Laboratory tests revealed hematuria (RBC30‒59/HPF), proteinuria (2.8 g/gCr), serum creatinine of 8.2 mg/dL, and BUN of 122 mg/dL, raising the suspicion of rapidly progressive glomerulonephritis (RPGN). The patient was admitted and started on emergency dialysis and glucocorticoid therapy. Anti‒neutrophil cytoplasmic antibody (ANCA) testing was negative, but renal biopsy confirmed the diagnosis of pauci‒immune crescentic glomerulonephritis. From day 36 of hospitalization, rituximab and simple plasma exchange were added to the treatment regimen. However, the renal function failed to improve, and she required the continuation of hemodialysis. This case highlights the importance of early intervention with glucocorticoids, immunosuppressive agents, and plasmapheresis for the treatment of patients with RPGN. It is critical to consider pauci‒immune crescentic glomerulonephritis even in ANCA‒negative RPGN patients following COVID‒19 infection.
