Treatment of antiphospholipid syndrome (APS) is controversial. We report a case of renal microangiopathy in a 40-year-old woman with APS. The nephropathy was isolated without signs of disseminated thrombotic microangiopathy or progressive systemic sclerosis. Similarities with sclerodermatous kidney and an increase in plasma renin activity led us to initiate treatment with aspirin and captopril, with excellent control of the renal syndrome. We believe this therapeutic regimen may be an effective means of treating the renal microangiopathy of APS.