Crescentic Glomerulonephritis Due to COVID-19 Infection

The COVID-19 pandemic has presented a serious challenge to Nephrologists as it led to severe kidney injury in the form of acute tubular necrosis, many of whom required renal replacement therapy. This was predominantly seen in people who developed severe respiratory manifestations like ARDS from the viral infection, cytokine storm and septic shock with unstable hemodynamics. It has also presented with various Glomerular injuries mainly collapsing glomerulopathy in high risk APOL1 genotype patient's, thrombotic microangiopathy related renal failure due to hyper coagulopathy and occasionally pauci-immune glomerulonephritis due to immune dysregulation. All the glomerular disorders due to COVID 19 infection have been described under an entity named COVAN (covid 19 associated nephropathy). Proteinuria was a predominant presentation in Glomerular disorders. Gross hematuria and AKI without any respiratory symptoms from COVID-19 infection have not been described so far in the literature. We have encountered a rare case of gross hematuria and severe acute renal failure who was found to have infection related crescentic glomerulonephritis due to active COVID-19 infections on kidney biopsy without any respiratory symptoms clinically. He has responded well to treatment with steroid taper and antiviral (Remdesivir). This is a very rare Renal manifestation of COVID-19 infection.