# The Pulsing Paradox: Successful Steroid Therapy in Infection-Related Glomerulonephritis

## TL;DR

A diabetic man with severe kidney infection and failure showed significant improvement after steroid treatment combined with antibiotics.

## Contribution

Demonstrates successful steroid therapy in infection-related glomerulonephritis with crescents, a rare and severe kidney condition.

## Key findings

- Steroid therapy under antibiotic cover led to near-complete resolution of renal failure in a patient with IRGN.
- The patient presented with bilateral pyelonephritis and MRSA infection, which was managed alongside steroid treatment.
- Renal biopsy confirmed IRGN with crescents, indicating severe inflammation and potential for rapid kidney damage.

## Abstract

The patterns of infection-related glomerulonephritis (IRGN) are rapidly changing in terms of age at presentation and sources of infection. The existing literature on the use of steroids in IRGN is inconsistent. A diabetic male in his sixties presented with features of anasarca, bilateral flank pain, and acute pulmonary edema. He had a non-healing ulcer over his right leg, with pus culture showing growth of methicillin-resistant Staphylococcus aureus (MRSA). Computed tomography (CT) of the kidneys, ureter, and bladder (KUB) showed features of bilateral pyelonephritis. The patient went on to develop acute renal failure and eventually required hemodialysis. A renal biopsy was performed, and features of IRGN with crescents were noted. Considering the presence of crescents in renal biopsy, a trial of steroids was given under antibiotic cover, which resulted in a near-complete resolution of renal failure.