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BackgroundCrescent formation generally reflects severe glomerular injury. There is sparse literature on post-infectious glomerulonephritis (PIGN) with crescents in adults. This retrospective study looked at nine such cases to see if there is a correlation between the severity of presentation, steroid treatment, histological severity and outcome.MethodsBiopsy reports of all the adults who underwent kidney biopsy from February 2010 to June 2014 in a tertiary care hospital were screened and all the cases with the diagnosis of PIGN with crescents were selected. Clinical presentation, laboratory data, histology, treatment and outcome were analysed.ResultsSix patients had evidence of recent/current infection, but all except two were non-streptococcal. The mean creatinine was 360.67 μmol/L (range 70.72–770.85) and the mean estimated glomerular filtration rate (MDRD eGFR) was 30.28 mL/min/1.73 m2 (range 6.4–111.1) on presentation. All five patients who were treated with steroids had an excellent response. Among the four patients who did not receive steroids, two were left with significant renal impairment (mean MDRD eGFR 23.5 mL/min/1.73 m2) at a mean follow-up of 15.5 months (range 10–21). The mean percentage of glomeruli with crescents was 36.13% (range 11.76–100) and except in one, there was no tubular atrophy or interstitial fibrosis and none had glomerulosclerosis. None of the patients progressed to end-stage renal disease.ConclusionNon-streptococcal infections are more common precipitants. There was no correlation between histological and clinical severity. Patients treated with steroids had better renal outcomes.

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The current pandemic caused by COVID, a primary respiratory pathogen, has resulted in a number of neurological manifestations following the infection. Reports of COVID positive patients with meningoencephalitis, Guillain Barre Syndrome and cerebrovascular accidents have surfaced over the past few months. Our patient, who developed respiratory involvement following infection with COVID, developed dysautonomia in the recovery phase, manifested as Postural Orthostatic Tachycardia Syndrome (POTS). The abnormal sympathetic skin response from lower limbs and an abnormal 30:15 ratio of RR interval in standing position shows the probable neuropathic aetiology of his POTS. Our case highlights the fact that this virus has multiple ways of affecting the nervous system and that a complaint of palpitations in a patient with COVID infection may be a neurological manifestation. In the scenario of the COVID pandemic and we need to be vigilant about dysautonomia as a probable complication of this infection.

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