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A favourable outcome using oral prednisolone and losartan only in a patient with ANCA-related glomerulonephritis: a discrepancy between histological activity and MPO-ANCA.

Antineutrophil cytoplasmic antibodies (ANCA) are usually diagnostic of pauci-immune crescentic glomerulonephritis. Pauci-immune crescentic glomerulonephritis often has a poor prognosis if not treated aggressively with immunosuppressants. A combination of high doses of corticosteroid and cyclophosphamide has been recommended as an induction therapy. Such therapy is not, however, without severe side-effects. We report a patient with biopsy-documented minimalchange nephropathy associated with a high myeloperoxidase (MPO)-ANCA titre, who responded favourably to moderate doses of oral prednisolone and losartan, an angiotensin II receptor antagonist. This case suggests that the therapy of ANCA-related glomerulonephritis could be adjusted according to the activity of the disease observed on renal histology.