Post-streptococcal infection-related glomerulonephritis presenting with acute kidney injury and severe hypoglycaemia in a patient with diabetes.

Infection-related glomerulonephritis (IRGN) in adults often arises in individuals with diabetes mellitus and can present with severe acute kidney injury (AKI). Because AKI impairs renal drug clearance, sulfonylureas (SU) may accumulate and precipitate profound hypoglycaemia. A 67 year-old man with type 2 diabetes mellitus was found unconscious and presented with severe hypoglycaemia (28 mg/dL) and marked AKI (serum creatinine 10.89 mg/dL) accompanied by oliguria and volume overload. Laboratory findings showed heavy proteinuria, haematuria, low complement C3, and elevated anti-streptolysin O titre, consistent with post-streptococcal IRGN. Haemodialysis was initiated for persistent oliguria. Renal biopsy was deferred because of a newly detected chronic subdural haematoma and deep vein thrombosis. Renal function gradually improved, and dialysis was discontinued by day 12. At 1 year, kidney function remained stable. This case illustrates that preceding infectious symptoms in diabetic patients may be subtle, delaying recognition of IRGN. The resulting AKI likely contributed to reduced SU clearance and severe hypoglycaemia at presentation. This case underscores the importance of considering IRGN as a cause of acute kidney injury in adults with recent or unrecognised infections, particularly in those with diabetes. When AKI occurs, clinicians should be vigilant regarding altered drug clearance and the potential for severe adverse events such as hypoglycaemia. Early evaluation of infection history, renal function, and medication safety is essential for timely diagnosis and management.