Crescentic Glomerulonephritis in A Child With Tea- Colored Urine: A Case Report

A 12-year-old girl was admitted with tea-colored urine for 24 hours. She had normal blood pressure and no edema with a rapid and progressive increase in blood urea nitrogen and serum creatinine, so one session of hemodialysis was done. The condition got worse by a thrombus formation in the heart. C4 was normal, but C3 was low, while serologic tests for lupus and Anti-Neutrophil Cytoplasmic Antibody (ANCA) were negative. Urinalysis showed proteinuria and hematuria. The kidney biopsy revealed crescentic glomerulonephritis. Treatment with 3 pulses of methylprednisolone and cyclophosphamide, and antithrombotic drugs were given with rapid recovery to normal serum creatinine and decrease in proteinuria. C3 was normalized after 2 months, and the clot disappeared, while hematuria and proteinuria continued as 1+ after 5 months. Due to the continuous proteinuria, Myfortic was continued for one year. Then, after stopping Myfortic, proteinuria did not return, and only microscopic hematuria continued. In conclusion, severe crescentic glomerulonephritis may have minimal symptoms and be complicated by heart thrombosis but with excellent response to medical therapy.