Role of Steroids in Post-streptococcal Glomerulonephritis Without Crescents on Renal Biopsy

Steroid is usually indicated in patients with post-streptococcal glomerulonephritis (PSGN) with more than 30% crescents on renal biopsy. The role of steroids in patients without crescentic glomerulonephritis is not clear. We present a 19-year-old male patient who was diagnosed with PSGN three weeks after a sore throat infection. He developed acute renal and respiratory failure requiring hemodialysis and mechanical ventilation. The renal biopsy confirmed PSGN, but did not show severe histological features such as crescents formation. Due to lack of clinical improvement, trials of pulse dose methylprednisolone were initiated with prompt improvement in renal and respiratory function. Our case suggested the potential role of high dose steroids in select patients of PSGN with progressive renal failure, development of multi-organ system deterioration, and failed conservative management irrespective of histological findings.