Mixed malaria infection presenting with infection-related glomerulonephritis

Glomerulonephritis is a rare but important renal manifestation of malaria, particularly in endemic regions. Infection-related glomerulonephritis (IRGN) associated with mixed-species malaria is infrequently reported and may present diagnostic and therapeutic challenges. We describe a 34-year-old man who presented with an acute febrile illness and was diagnosed with mixed-species malaria due to Plasmodium vivax and Plasmodium falciparum . During hospitalisation, he developed acute kidney injury (AKI) with oliguria and hyperkalaemia, requiring supportive management. Renal function initially improved following antimalarial therapy and supportive care; however, three weeks later he experienced secondary deterioration with worsening serum creatinine, nephrotic-range proteinuria, microscopic haematuria, hypertension, and low serum C3 levels. Kidney biopsy demonstrated exudative proliferative glomerulonephritis consistent with IRGN. In the setting of dialysis dependence and after exclusion of ongoing infection, corticosteroid therapy was initiated, leading to recovery of renal function and normalisation of C3 levels. Persistent sub-nephrotic range proteinuria and microscopic haematuria raised concern for C3 glomerulopathy, prompting repeat biopsy, which revealed resolving IRGN with secondary focal segmental glomerulosclerosis (FSGS). This case illustrates that IRGN can occur as a delayed immune-mediated complication following mixed-species malaria and may evolve into secondary FSGS despite apparent clinical improvement. Vigilant follow-up, timely repeat histopathological evaluation, and a multidisciplinary approach are essential for optimising renal outcomes in malaria-associated nephropathy.