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Scleroderma renal crisis: poor outcome despite aggressive antihypertensive treatment

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Abstract:

Abstract Background: 

Scleroderma renal crisis (SRC) is a rare but feared complication of scleroderma. Angiotensin-¬≠converting enzyme (ACE) inhibition has significantly improved survival, but it is unknown whether prophy¬≠lactic ACE inhibitors will prevent this complication. Aims: 

To determine: (i) the frequency of SRC in our cohort of well-characterized scleroderma patients resident in South Australia, (ii) any predisposing clinical and serological features, (iii) median disease duration at which SRC occurs, (iv) possible precipitants, (v) disease outcome, and (vi) whether patients were taking ACE inhibitors prior to onset of SRC. Methods: 

Systematic review of the clinical course of all patients registered on the South Australian Scleroderma Register. Results: 

SRC occurred in 16 patients. This constituted 2.8% of a total scleroderma cohort and 15% of the diffuse scleroderma cohort identified in South Australia. All 16 patients had diffuse cutaneous scleroderma. SRC occurred at a median disease duration of 15 months (range 1 week− 11 years). Disease outcome was poor (five deaths, three requiring long-term dialysis and only two patients regaining a normal creatinine) despite aggressive antihypertensive treatment (including ACE inhibitors) in an intensive care or specialized renal unit. Two patients were later able to discontinue dialysis. Only two patients were taking small doses of ACE inhibitors prior to the onset of their SRC. The frequency of Scl-70 was decreased in the SRC group (P = 0.003). Conclusion: 

SRC is a rare event occurring in a small proportion of patients with diffuse scleroderma. The outcome of SRC was poor despite aggressive antihypertensive treatment. It is hypothesized that prophylactic ACE inhibition in susceptible patients might prevent or ameliorate this complication. (Intern Med J 2003; 33: 216−220)

Keywords: angiotensin-converting enzyme inhibitors; disease outcome; scleroderma; scleroderma renal crisis

Document Type: Original Article

DOI: https://doi.org/10.1046/j.1445-5994.2003.00358.x

Affiliations: 1: Immunology, Allergy and Arthritis and 2: Anatomy and Histology, Flinders Medical Centre, 3: Queen Elizabeth Hospital and 4: Department of Medicine, University of Adelaide, Adelaide, South Australia, Australia

Publication date: 2003-05-01

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