Acute poststreptococcal glomerulonephritis (PSGN) is uncommonly seen in the elderly population and its diagnosis is not without some difficulty because clinical manifestations may mimic other diseases. Renal biopsy for diagnosis and early intervention, if indicated, is very valuable in such a situation. We present here a case of an elderly patient with PSGN and a review of the literature. In addition to the typical clinical manifestations of the disease, dyspnea and pulmonary congestion are commonly present in elderly patients, probably a result of excessive salt and water retention in the face of compromised cardiovascular function. Elderly patients with PSGN appear to have a remarkably poor prognosis, with significant incidences of acute mortality and chronic renal disease. Our patient had the unusual finding of a large number of glomerular crescents with near complete clinical recovery after short-term follow-up.