Scleroderma renal crisis: patient characteristics and long-term outcomes.
BACKGROUND
Scleroderma renal crisis (SRC) is an important complication of systemic sclerosis, causing acute renal failure, and usually hypertension.


OBJECTIVE
To review the clinical and pathological features of SRC, and correlate them with renal outcomes and mortality.


METHODS
Retrospective case series.


METHODS
We identified 110 cases of SRC managed at a single centre between 1990 and 2005.


RESULTS
SRC occurred in 5% of scleroderma cases under follow-up. Cases were predominantly female (81%), with diffuse cutaneous disease (78%). RNA polymerase antibodies were found in 59% of cases tested. Almost all (108/110) received treatment with ACE inhibitors (ACEIs). Dialysis was not required in 36%, was required temporarily (for up to 3 years) in 23%, was required permanently in 41%. Patients not on dialysis showed improvement in estimated glomerular filtration rate after SRC (mean change +23 ml/min over 3 years). Poor renal outcome was associated with lower blood pressure at presentation, and with higher age in those requiring dialysis. Steroid use, microangiopathic haemolytic anaemia, and antibody profile were not related to renal outcome. In the 58 renal biopsies available for clinical correlation, acute changes of mucoid intimal thickening in arteries and fibrinoid necrosis in arterioles were associated with a poorer renal outcome. Mortality was high (59% survival at 5 years), and was higher in men.


CONCLUSIONS
Despite the efficacy of ACEIs in managing SRC, the poor long-term outcome warrants evaluation for additional treatments for this devastating complication of systemic sclerosis.
Penn
H
H
Department of Rheumatology, Royal Free Hospital, London, UK. h.penn@medsch.ucl.ac.uk
Howie
A J
AJ
Kingdon
E J
EJ
Bunn
C C
CC
Stratton
R J
RJ
Black
C M
CM
Burns
A
A
Denton
C P
CP
D058186:Acute Kidney Injury / Q000209:etiology* / Q000401:mortality / Q000628:therapy; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D005260:Female; D006801:Humans; D006977:Hypertension, Renal / Q000209:etiology* / Q000401:mortality / Q000628:therapy; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis; D012189:Retrospective Studies; D012595:Scleroderma, Systemic / Q000150:complications*; D016019:Survival Analysis; D016896:Treatment Outcome
D000806:Angiotensin-Converting Enzyme Inhibitors