A 51-year-old man with a no prior comorbidity referred to our hospital with AKI, anuria and hemoptysis. The patient, who had two doses of biontech mRNA vaccine (last one 8 months ago), was positive for COVID-PCR test about 2 months ago due to complaints of runny nose, fever and fatigue. No hospitalization or medical treatment was required during the COVID-19 infection and the patient became PCR-negative. However, fifteen days after the PCR negativity, the patient started to complain of weakness, loss of appetite, joint pain and nausea. Hemoptysis started with coughing almost every day. In the last ten days, the patient's urine output gradually decreased, He was admitted to the local hospital with these complaints. Chest computed tomography (CT) showed cavitary lesion with central opacification in the right pulmonary apex and ground-glass shadowing in the lungs bilaterally. (Fig. 1) Bacterial and fungal infection of lungs were ruled out. Also, Tuberculosis culture of sputum, asido-resistance bacilli (ARB) staining and immunological tests including PR3-ANCA and MPO-ANCA, ANA, anti-GBM were all negative. The patient, whose creatinine level increased progressively is referred to our hospital because of his worsening clinic, need of hemodialysis and evaluation for pulmonary renal syndrome. At admission, labs revealed serum creatinine 12.02 mg/dl, estimated glomerular filtration rate (eGFR) 4 ml/min/1.73 m², blood urea nitrogen (BUN) 118.65 mg/dl, albumin 2,7 g/dl and C-reactive protein level of 292 mg/dl. In the urine analysis proteinuria and erythrocyturia were found. Severe anemia was observed with normal platelet count and elevated white blood cells count. On admission, the patient was tachypneic and hypoxic. Within two hours of admission, he was urgently intubated due to respiratory failure secondary to sudden developed massive pulmonary hemorrhage. The clinical appearance was so devastating that treatment with IV pulse steroid 1000 mg and plasmapheresis was started immediately without serologic and/or tissue diagnosis by kidney biopsy. However, re-examination of serologic tests revealed positive result for PR-3ANCA. Then, 500 mg intravenous pulse cyclophosphamide applied, and plasmapheresis treatment was completed to 5 sessions. After induction with 1000 mg pulse steroid for three days, steroid dose decreased gradually to 80 mg intravenous prednisolone as maintenance dose. The patient was taken to intermittent hemodialysis due to uremia and anuria. Tracheostomy was performed in the intensive care unit for the patient since being intubated for a long time. The patient's hypoxia regressed day by day, urine output gradually increased, his tracheostomy was closed, kidney functions improved, and he was discharged with recovery after a 50-day intensive care hospitalization. (Fig. 2, Fig. 3) We planned maintenance therapy with 60 mg oral prednisolone daily and 500 mg pulse cyclophosphamide with 15 days intervals.