A 86-year-old man had been treated for
hypertension,
diabetes mellitus (DM), and
dyslipidemia in Nihonkoukan Hospital. His renal function was within the normal range in August 2007. He showed
common cold-like symptoms, which were not improved by anti-inflammatory drugs in December 2007. He was admitted to our hospital because of
renal failure, urine
protein and urine occult blood. He was also positive for anti-
myeloperoxidase antibody (MPO-
ANCA; 129 IU/mL). A renal biopsy revealed idiopathic crescentic
glomerulonephritis of the pauci immune type. Considering his advanced age and DM, he was treated with the low dose of 20 mg/day of
prednisolone. Although his symptoms, such as low grade
fever and general
fatigue, were improved after
steroid therapy,
renal failure accelerated, necessitating
hemodialysis (HD), and
insulin administration was needed for his DM. Subsequently, an AV fistule operation for HD was performed.
Prednisolone was tapered to 17.5 mg/day after 4 weeks, and his MPO-
ANCA titer decreased to 87 IU/mL. After
steroid treatment and HD, his condition gradually recovered and he was discharged on March 5, 2008. Following about 6 months of treatment with
prednisolone (3.5 months after HD administration), his renal function gradually recovered, allowing the discontinuation of HD. High-dose
steroid therapy is very effective for
ANCA-related
glomerulonephritis. However, there is a high risk of
infection, especially in aged and DM patients. Low-dose
steroid therapy (PSL 20 mg/day) is safe and effective in such high-risk patients and in some cases, they can be released from HD.