To the Editor: A 7-y-old boy presented with cola-colored urine for 7 d, with oliguria for 2 d. Two weeks ago, he and his mother had fever with multiple vesicular lesions all over the body. There was no pharyngitis or pyoderma. On examination, his blood pressure (BP) was 119/83 mm Hg (>95th centile), and he had periorbital edema, multiple healed varicella rashes and moderate ascites. Investigations showed hemoglobin 10 g/dL; total leukocyte count 8760/mm3; and platelet count 190 × 109/L. Urinalysis showed proteinuria 2+, and microscopic hematuria with 80% dysmorphic RBCs. Serum creatinine was 4.99 mg/dL, urea 132 mg/dL, sodium 132 mEq/L, potassium 4.99 mEq/L, serum albumin 2.34 g/dL, serum C3 135 mg/dL, and anti-streptolysin O was negative. He was diagnosed as rapidly-progressive glomerulonephritis (RPGN) with normocomplementemia. The renal biopsy specimen showed 25 glomeruli with increased mesangial proliferation; 7/25 glomeruli showed cellular crescents, tubules showed few RBC casts. Direct immunofluorescence revealed IgA and C3 2+ (M1E1S0T0C1 as per Oxford classification of IgA nephropathy 2016) [1]. The child received intravenous methylprednisolone pulses followed by monthly-intravenous cyclophosphamide pulses along with oral prednisolone. He underwent 8 sessions of hemodialysis, following which urine output normalized. At 3 mo follow-up, serum creatinine was 0.47 mg/dL, serum albumin 3.5 g/dL, nil proteinuria and BP well-controlled with amlodipine and enalapril.

Varicella-associated glomerulonephritis is rare and generally resembles post-streptococcal glomerulonephritis [2]. However, immune complex-membranoproliferative glomerulonephritis [3], Henoch Schönlein purpura (HSP) nephritis [4], and mesangioproliferative glomerulonephritis [2] are reported anecdotally following varicella, due to direct viral invasion or immune-mediated mechanisms [2]. Our patient had IgA nephropathy following varicella; a hitherto unreported association. Timely management of crescentic-IgA nephropathy resulted in favourable outcomes. Since HSP has been described earlier following varicella [4]; intuitively, IgA nephropathy too could follow varicella, since HSP nephritis and IgA nephropathy are related disorders. Our report adds IgA nephropathy to the constellation of glomerulopathies that may follow varicella infection.