COVID-19 Linked Crescentic Glomerulonephritis with Hematuria in Patients Without Respiratory Symptoms Raises New Concerns!
Nikhil Prasad Fact checked by:Thailand Medical News Team May 10, 2025 3 hours, 12 minutes ago
Medical News: A surprising medical case from the United States has shed light on a rare and potentially dangerous kidney condition—crescentic glomerulonephritis—caused by COVID-19 infection. What makes this case especially unique is that the patient had no respiratory symptoms whatsoever, yet suffered from severe hematuria (the presence of blood in urine) and acute kidney injury. This unusual presentation has prompted researchers and nephrologists to reevaluate how COVID-19 might silently trigger serious organ damage.
COVID-19 Linked Crescentic Glomerulonephritis with Hematuria in Patients Without Respiratory
Symptoms Raises New Concerns!
The case was documented by researchers from Allina Health in Minneapolis, the Mayo Clinic in Rochester, and UPMC in Cumberland. It’s among the first to identify a direct link between an active COVID-19 infection and crescentic glomerulonephritis without the typical signs of a respiratory illness. This
Medical News report outlines in detail how this rare form of kidney inflammation was discovered, treated, and eventually brought under control.
An Unexpected Medical Mystery
A 69-year-old man visited the emergency room complaining of severe hematuria lasting one week. While he had no recent infections or respiratory complaints, his medical history included conditions like obesity, high blood pressure, and psoriasis. His initial blood work revealed elevated creatinine levels—a sign of kidney dysfunction—and further tests showed large amounts of red blood cells and protein in his urine. His blood pressure was extremely high at 200/100 mmHg.
Despite aggressive hydration and antibiotics, his kidney function worsened. After being briefly discharged, he returned with fatigue, flank pain, and worsening hematuria. This time, his creatinine level had jumped to 5.7 mg/dL, and his urine output had significantly decreased. He tested positive for SARS-CoV-2, the virus that causes COVID-19, although he never had a cough or fever.
Kidney Biopsy Uncovers the Culprit
To determine the cause of his kidney failure, doctors performed a kidney biopsy. The results were eye-opening. Under the microscope, his kidney tissue showed clear signs of crescentic glomerulonephritis—a severe inflammatory condition where the kidney’s filtering units (glomeruli) become scarred and dysfunctional.
Further staining techniques revealed C3 complement protein deposits, tubuloreticular inclusion bodies (signs of viral immune activation), and necrosis. These patterns confirmed that the glomerular inflammation was likely caused by an ongoing COVID-19 infection, rather than a typical bacterial cause or a chronic autoimmune condition.
The patient was immediately started on a five-day course of the antiviral Remdesivir along with pulse steroids and a long tapering dose of oral prednisone.
A Remarkable Recovery
Over the cour
se of three months, the man’s kidney function steadily improved. His creatinine levels dropped from a high of 6.4 mg/dL to a stable 1.8 mg/dL, and his estimated glomerular filtration rate (eGFR)—a key measure of kidney function—rose to 35 mL/min. Urinalysis showed that the blood in his urine decreased substantially, and protein levels also normalized. His blood pressure came under control with medication, and he resumed a relatively normal life.
What Is Crescentic Glomerulonephritis and Why Does It Matter?
Crescentic glomerulonephritis (GN) is a rare but severe form of kidney inflammation. It gets its name from the crescent-shaped scars that appear on biopsy samples of the kidney’s filtering units. If left untreated, it can rapidly lead to end-stage renal disease, requiring dialysis or a transplant.
Traditionally, this condition is linked to autoimmune disorders or severe bacterial infections, not viral illnesses. But the presence of crescentic GN in a patient with no known autoimmune markers—but with an active COVID-19 infection—suggests that the virus can directly inflame and damage kidney tissues.
Why This Case Changes the Game
Until now, COVID-19’s impact on the kidneys was mostly seen in critically ill patients with conditions like acute tubular necrosis or collapsing glomerulopathy. Those with predisposing genetic risks (like high-risk APOL1 genotypes) were thought to be more vulnerable. What this case demonstrates is that even a mild or silent COVID-19 infection can cause severe kidney damage through unique pathways involving the complement system and immune overactivation.
The study also highlights the role of ACE2 receptors, which are heavily expressed in kidney cells. These receptors act as the virus's entry point, allowing SARS-CoV-2 to infect kidney tissue even in the absence of lung involvement. The subsequent immune response can trigger inflammation, blood clots in the small vessels, and activation of complement proteins like C3, which cause further injury.
Other Glomerular Disorders Linked to COVID-19
This case is part of a growing body of evidence showing that COVID-19 can cause a wide range of kidney disorders, now collectively referred to as COVAN (COVID-19-associated nephropathy). These include:
-Collapsing glomerulopathy (especially in Black patients with APOL1 gene variants)
-IgA nephropathy
-Membranous nephropathy (PLA2R-mediated)
-Minimal change disease
-ANCA-associated vasculitis
-Anti-glomerular basement membrane disease
Each of these conditions reflects different immune and inflammatory pathways triggered by the virus or, in some cases, by vaccination.
A Wake-Up Call for Clinicians
This report emphasizes that healthcare professionals must maintain a high index of suspicion for kidney complications in COVID-19 patients—even in those who appear asymptomatic. If hematuria and rising creatinine levels are observed, a kidney biopsy should be considered early to avoid long-term damage.
It also underlines the importance of timely antiviral and immunosuppressive treatment, which helped this patient avoid dialysis and recover kidney function.
Final Thoughts
This case of COVID-19-induced crescentic glomerulonephritis with hematuria is a sobering reminder that the virus’s impact goes beyond the lungs. Silent or mild infections can still lead to life-threatening organ damage, making early detection and treatment crucial. As more such cases come to light, it is clear that COVID-19’s reach is far deeper and more complex than initially thought. Medical researchers and clinicians will need to stay alert to protect patients from these hidden dangers.
The study findings were published in the peer reviewed Journal of Clinical Medicine.
https://www.mdpi.com/2077-0383/14/10/3302
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Read Also:
https://www.thailandmedical.news/news/covid-19-infection-triggers-different-kidney-damage-patterns-depending-on-existing-kidney-health
https://www.thailandmedical.news/news/how-covid-19-impacts-kidney-health-and-increases-risk-of-chronic-kidney-disease
https://www.thailandmedical.news/news/study-warns-that-the-deposition-of-sars-cov-2-protein-in-the-kidneys-are-worsening-post-covid-renal-conditions
https://www.thailandmedical.news/articles/coronavirus
https://www.thailandmedical.news/pages/thailand_doctors_listings
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