Abstract: FR-PO0775
Navigating Infection Triggered Crescentic Glomerulonephritis (GN): Achieving Remission Without Immunosuppression
Session Information
- Glomerular Diseases: ANCA Vasculitis, Anti-GBM Disease, and Crescentic GN
October 23, 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
- Jan, Muneeb Ullah, The University of Tennessee Health Science Center Department of Medicine, Memphis, Tennessee, United States
- Vo, Hieu Q., The University of Tennessee Health Science Center Department of Medicine, Memphis, Tennessee, United States
- Zabiullah, Syed Mohammed Faizaan, The University of Tennessee Health Science Center Department of Medicine, Memphis, Tennessee, United States
- Khaliq, Muhammad, The University of Tennessee Health Science Center Department of Medicine, Memphis, Tennessee, United States
- Rafaey, Wania, The University of Tennessee Health Science Center Department of Medicine, Memphis, Tennessee, United States
Introduction
Infection-related glomerulonephritis (IRGN) is typically associated with Streptococcus pyogenes or Staphylococcus. Escherichia coli is a rare trigger. When biopsy reveals crescentic morphology and nephrotic-range proteinuria, a clinical dilemma arises regarding the use of immunosuppression. We describe a case of E. coli-induced IRGN with crescentic features that achieved full remission through conservative management alone
Case Description
A 35-year-old female (BMI 34) with no significant history presented with acute cystitis. She was treated with cefdinir and metronidazole. Two weeks later, she presented with progressive dyspnea and chest pain. Labs showed a BNP of 1669 pg/mL; chest radiography confirmed pulmonary edema and cardiomegaly. Evaluation revealed nephrotic syndrome (24-hour urine protein 13g; UPCR >7.1 g/g), depressed C3 levels, and an E. coli positive urine culture. Renal biopsy showed diffuse proliferative and exudative GN with focal cellular crescents. Immunofluorescence demonstrated isolated C3 deposits, diagnostic of IRGN. Given the active infection and lack of other systemic triggers, immunosuppression was withheld. Treatment included diuretics and antibiotics. At two-week follow-up, her symptoms resolved and proteinuria improved dramatically (UPCR 0.3g/g, ACR 177mg/g), marking a complete clinical recovery.
Discussion
Crescents and nephrotic-range proteinuria often signal a severe course but do not mandate immunosuppression in IRGN. Because the condition is often self-limiting once the pathogen is cleared, premature immunosuppressants risk exacerbating the underlying infection. Renal biopsy is indispensable to secure the diagnosis and tailor management, avoiding unnecessary toxicity.
cellular crescents