Renal function is mostly preserved in patients with systemic sclerosis.
OBJECTIVE
Chronic renal disease other than scleroderma renal crisis (SRC) is not well documented in systemic sclerosis (SSc). We examined the occurrence of decreased glomerular filtration rate (GFR) in a large consecutive SSc cohort and analysed whether it was related to SSc or could be related to other causes.


METHODS
During 1983-2004 GFR was measured by chromium-51-ethylenediaminetetraacetic acid (51Cr-EDTA) or iohexol clearance in 461 patients with SSc according to the American College of Rheumatology (ACR) criteria [356 with limited cutaneous SSc (lcSSc) and 105 with diffuse cutaneous SSc (dcSSc)] and the measurements were repeated once a year. Decreased GFR was defined as GFR<70% of the age-adjusted values. SRC was diagnosed in 4/360 lcSSc (1.1%) and in 10/115 dcSSc (8.7%). These patients were excluded from further analyses.


RESULTS
At the latest follow-up at a median duration of 7.7 (range 0.5-54) years, decreased GFR was found in 39 lcSSc (11%) and nine (8.6%) dcSSc patients. Among the 48 SSc patients with GFR< 70p% (percentage of predicted value = p%), hypertension was diagnosed in 29 (60%) and cardiac involvement in 25 (52%). Different nephropathies were found in eight (19%) patients by renal biopsy. Fifteen patients with decreased GFR were followed up for > or = 4 years and no progress was seen in 11/15.


CONCLUSIONS
A minority of patients with SSc develop renal dysfunction other than SRC. Decreased GFR was associated with other manifestations such as hypertension and cardiac involvement indicating possible pre-renal causes.
Scheja
A
A
Department of Rheumatology, University Hospital, Lund, Sweden. Agneta.scheja@med.lu.se
Bartosik
I
I
Wuttge
D M
DM
Hesselstrand
R
R
D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000974:Antibodies, Antinuclear / Q000097:blood* / Q000276:immunology; D002423:Cause of Death; D015331:Cohort Studies; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate / Q000502:physiology*; D006801:Humans; D007677:Kidney Function Tests; D008297:Male; D008875:Middle Aged; D011336:Probability; D012016:Reference Values; D012189:Retrospective Studies; D018570:Risk Assessment; D012595:Scleroderma, Systemic / Q000150:complications / Q000401:mortality* / Q000503:physiopathology*; D012720:Severity of Illness Index; D012737:Sex Factors; D018709:Statistics, Nonparametric; D016019:Survival Analysis; D013997:Time Factors; D055815:Young Adult
D000974:Antibodies, Antinuclear