Kidney Week

Abstract: SA-PO0736

Severe Postinfectious Glomerulonephritis: Steroid Benefit at a Cost

Session Information

• Glomerular Diseases: Complement-Mediated Glomerulopathies and Infection-Related GN
  October 24, 2026 | Location: Exhibit Hall A, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Glomerular Diseases

• 1402 Glomerular Diseases: Clinical, Outcomes, and Therapeutics

Authors

• Berbari, Iskandar, Emory University School of Medicine, Atlanta, Georgia, United States

Iskandar Berbari, MD

• Johnson, Sarah Ann, Emory University School of Medicine, Atlanta, Georgia, United States

Sarah Ann Johnson, MD

• Shackelford, Rondey E., Emory University School of Medicine, Atlanta, Georgia, United States

Rondey E. Shackelford, DO

• Waheed, Sana, Emory University School of Medicine, Atlanta, Georgia, United States

Sana Waheed, MD, FASN

Introduction

A case of severe Post-Infectious Glomerulonephritis (PIGN) which was successfully treated with steroids.

Case Description

51-year-old male with past medical history of uncontrolled type 2 DM was admitted with blurry vision and a painful skin rash along with edema in his legs. He had proteinuria of 3.2g/g along with an AKI with a creatinine of 2.7mg/dL. Urine microscopy showed > 50 RBCs/ hpf but no dysmorphic RBCs or RBC casts. C3 and C4 were low at 22 mg/dL and 18 mg/dL. ASO titre was elevated at 414IU/L (normal <200IU/L). He was diagnosed with bullous impetigo and treated with doxycycline and cephalexin. Given worsening creatine, he underwent a kidney biopsy 5 days after admission. Biopsy showed immune complex exudative glomerulonephritis (GN) with IgG and C3 predominance on immunofluorescence with sub endothelial and mesangial deposits, most consistent with PIGN. Despite treatment of infection, his kidney function continued to worsen. He was started on prednisone 60 mg daily on day 9 given lack of improvement in kidney function and the degree of proliferation seen on the biopsy. On day 11, he had continued worsening of kidney function with BUN increasing to 121 mg/dL and creatinine to 7.5mg/dL with persistent hyperkalemia, so intermittent hemodialysis was initiated. He had two dialysis sessions. His urine output started improving with improvement in creatinine down to 2.2 mg/dL in about 1 week. Steroids were quickly tapered over a 2 week period as an outpatient. Patient was readmitted 2 weeks later with septic arthritis of the knee, MSSA bacteremia and septic shock. He was successfully treated with antibiotics and stress dose steroids.

Discussion

This case highlights that PIGN may progress despite supportive care alone. Although steroids were associated with renal recovery in our patient, they were followed by life-threatening MSSA bacteremia, underscoring the limited treatment options for refractory PIGN and the significant risks of immunosuppression. This case emphasizes the need for stronger evidence to guide therapy in severe PIGN.