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The first, established on antiretroviral therapy, presented with a pulmonary-renal syndrome after empirical anti-tubercular treatment had failed; biopsy showed cellular crescents without chronic change, and corticosteroids with rituximab achieved sustained clinical, biochemical and serological remission. The second, antiretroviral-naive, had glomerular haematuria and proteinuria documented at HIV diagnosis and an ischaemic stroke soon afterwards, but declined nephrological assessment; biopsy 3 years later was dominated by global glomerulosclerosis and interstitial fibrosis and he remained dialysis-dependent. The divergence turned on the histological stage at diagnosis rather than antiretroviral status and argues for early biopsy whenever unexplained renal decline with an active urinary sediment occurs in HIV.<\/jats:p>","DOI":"10.1136\/bcr-2025-270865","type":"journal-article","created":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T12:20:15Z","timestamp":1786969215000},"page":"e270865","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Pauci-immune crescentic glomerulonephritis in human immunodeficiency virus infection: clinical and therapeutic challenges"],"prefix":"10.1136","volume":"19","author":[{"given":"Pranjal","family":"Kashiv","sequence":"first","affiliation":[{"name":"Nephrology, AIIMS Nagpur, Nagpur, Maharashtra, India"},{"name":"Nephrology, Datta Meghe Institute of Higher Education and Research Deemed to be University, Wardha, Maharashtra, 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