Predictors and risk factors for recurrent scleroderma renal crisis in the kidney allograft: case report and review of the literature.
Scleroderma renal crisis (SRC) can lead to end-stage renal disease (ESRD) and subsequent need for dialysis and/or renal transplantation. We review all reported cases of renal transplantations in scleroderma patients from PubMed search, present UNOS data on transplant outcomes, and identify predictors for allograft SRC. Of the five cases with recurrent SRC, all developed ESRD within a year of onset of native kidney SRC, whereas none of those who developed ESRD more than 1-2 years after the onset of SRC developed recurrence. Anemia preceded allograft SRC in two cases, pericardial effusion in one, and skin tightening in two others. UNOS data (October 1987-July 2004) documented 260 transplants performed for the renal diagnosis of scleroderma, with a 5-year graft survival rate of 56.7%. The risk for allograft SRC recurrence appears to correlate with early native renal function loss following the onset of SRC. Recurrent SRC in the allograft may be heralded by multiple clinical markers known to be predictive of severe scleroderma, including progression of diffuse skin thickening, new-onset anemia and cardiac complications.
Pham
Phuong-Thu T
PT
David Geffen School of Medicine at UCLA, Nephrology Division, Kidney and Pancreas Transplantation, Los Angeles, CA, USA. PPham@mednet.ucla.edu
Pham
Phuong-Chi T
PC
Danovitch
Gabriel M
GM
Gritsch
H Albin
HA
Singer
Jennifer
J
Wallace
William D
WD
Hayashi
Rick
R
Wilkinson
Alan H
AH
D000740:Anemia / Q000175:diagnosis; D001160:Arterioles / Q000473:pathology; D001327:Autoimmune Diseases / Q000150:complications; D018450:Disease Progression; D004487:Edema / Q000473:pathology; D005260:Female; D005337:Fibrin / Q000737:chemistry / Q000378:metabolism; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D007668:Kidney / Q000473:pathology; D007674:Kidney Diseases; D007676:Kidney Failure, Chronic / Q000175:diagnosis* / Q000209:etiology / Q000473:pathology*; D007678:Kidney Glomerulus / Q000473:pathology; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000379:methods*; D007684:Kidney Tubules / Q000473:pathology; D007963:Leukocytes, Mononuclear / Q000166:cytology; D008214:Lymphocytes / Q000378:metabolism; D008875:Middle Aged; D010490:Pericardial Effusion / Q000175:diagnosis; D039781:PubMed; D012008:Recurrence; D006435:Renal Dialysis; D012307:Risk Factors; D012595:Scleroderma, Systemic / Q000150:complications*; D012867:Skin / Q000473:pathology; D013927:Thrombosis / Q000473:pathology; D013997:Time Factors; D014184:Transplantation, Homologous / Q000379:methods
D005337:Fibrin