[Anti-RNA polymerase III antibodies in scleroderma renal crisis].
METHODS
A 67-year old patient underwent a kidney biopsy because of newly diagnosed hypertension, haemolytic anemia with fragmentocytes and acute kidney failure requiring dialysis therapy. The biopsy showed thrombotic microangiopathy. Since last winter Raynaud's phenomenon and changes of hands and lips were recognised.


METHODS
Initial immunological tests revealed anti-nuclear antibodies (ANA) but neither anti-centromere nor anti-Scl70 antibodies. The positive analysis of anti-RNA polymerase III antibodies confirmed the clinical suspicion of scleroderma renal crisis in the setting of first diagnosis of systemic sclerosis.


METHODS
After diagnosis therapy with lisinopril, candesartan and amlodipin was established. Four months after discharge dialysis dependency persisted.


CONCLUSIONS
Scleroderma renal crisis is an important differential diagnosis in the setting of acute kidney failure. Medical history, clinical examination and immunological test confirm the diagnosis. The mainstay of therapy is aggressive blood pressure control with ACE-inhibitors (or angiotensin receptor blocking agents).
Schorn
R
R
Klinik für Nephrologie, Universitätsspital Zürich, Schweiz.
Gaspert
A
A
Cohen
C D
CD
D000368:Aged; D017311:Amlodipine / Q000627:therapeutic use; D047228:Angiotensin II Type 1 Receptor Blockers / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D000974:Antibodies, Antinuclear / Q000097:blood*; D001562:Benzimidazoles / Q000627:therapeutic use; D001706:Biopsy; D001713:Biphenyl Compounds; D003131:Combined Modality Therapy; D003937:Diagnosis, Differential; D006801:Humans; D007668:Kidney / Q000473:pathology; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000188:drug therapy / Q000276:immunology* / Q000473:pathology; D007678:Kidney Glomerulus / Q000473:pathology; D017706:Lisinopril / Q000627:therapeutic use; D008297:Male; D010956:Plasmapheresis; D012319:RNA Polymerase II / Q000276:immunology*; D006435:Renal Dialysis; D012595:Scleroderma, Systemic / Q000175:diagnosis / Q000188:drug therapy / Q000276:immunology* / Q000473:pathology; D013777:Tetrazoles / Q000627:therapeutic use; D057049:Thrombotic Microangiopathies / Q000175:diagnosis / Q000188:drug therapy / Q000276:immunology / Q000473:pathology; D014665:Vasodilator Agents / Q000627:therapeutic use
D047228:Angiotensin II Type 1 Receptor Blockers; D000806:Angiotensin-Converting Enzyme Inhibitors; D000974:Antibodies, Antinuclear; D001562:Benzimidazoles; D001713:Biphenyl Compounds; D013777:Tetrazoles; D014665:Vasodilator Agents; D017311:Amlodipine; D017706:Lisinopril; D012319:RNA Polymerase II; C081643:candesartan