Renal manifestations in scleroderma: evidence for subclinical renal disease as a marker of vasculopathy.
Scleroderma is a disease characterized by immune activation, vasculopathy, fibroblast stimulation, and connective tissue fibrosis. End-organ damage occurs due to progressive tissue fibrosis and vasculopathy. Markers of incipient vasculopathy have not been well studied in scleroderma. However, reduced renal functional reserve and proteinuria are common indicators of progressive vasculopathy in diabetic and hypertensive vasculopathy. Recent studies suggest a strong association between renal involvement and outcomes in scleroderma, with a threefold increased risk of mortality from pulmonary hypertension if renal insufficiency is present. We review the types of renal involvement seen in scleroderma and the data to support the use of renal parameters including proteinuria, glomerular filtration rate, and renal vascular dynamics measured with Doppler ultrasound to identify subclinical renal insufficiency. Further studies are warranted to investigate the use of renal parameters as prognostic indicators in scleroderma.
Shanmugam
Victoria K
VK
Division of Rheumatology, Immunology and Allergy, Georgetown University Hospital, 3800 Reservoir Road, N.W, Washington, DC 20007, USA.
Steen
Virginia D
VD
Kidney Int. 2003 Feb;63(2):438-46
12631109
J Rheumatol. 1986 Oct;13(5):911-6
3546686
J Clin Lab Anal. 2001;15(4):178-83
11436199
Circulation. 2004 Jul 6;110(1):32-5
15210602
Clin Nephrol. 2008 Aug;70(2):110-7
18793526
Nephrologie. 1982;3(2):85-91
7121705
J Am Soc Nephrol. 2004 Feb;15(2):251-60
14747371
Arthritis Rheum. 1989 Sep;32(9):1128-34
2775321
N Engl J Med. 2004 Sep 23;351(13):1344-6
15385664
Rheumatology (Oxford). 2001 Jan;40(1):111-2
11157154
Rheum Dis Clin North Am. 2008 Feb;34(1):1-15; v
18329529
Radiology. 1997 Apr;203(1):82-6
9122420
Rheumatology (Oxford). 2009 Jun;48 Suppl 3:iii32-5
19487221
Br J Rheumatol. 1995 Nov;34(11):1048-54
8542206
QJM. 1998 Aug;91(8):561-6
9893759
Arthritis Rheum. 1988 Mar;31(3):393-400
3358801
J Rheumatol. 1988 Feb;15(2):202-5
3361530
Rheumatology (Oxford). 2003 Jan;42(1):26-33
12509609
Am J Respir Crit Care Med. 2010 Jul 15;182(2):252-60
20339143
Rheumatology (Oxford). 2009 Jun;48 Suppl 3:iii3-7
19487220
N Engl J Med. 2004 Sep 23;351(13):1296-305
15385656
Am J Med. 1996 Oct;101(4):387-94
8873509
Nature. 1990 Aug 2;346(6283):425-34
1974032
J Rheumatol. 1997 Oct;24(10):1944-8
9330936
Lancet. 2010 Apr 10;375(9722):1296-309
20382326
Acta Pharmacol Sin. 2009 Sep;30(9):1283-8
19730428
J Rheumatol. 2005 Apr;32(4):649-55
15801020
Circulation. 2002 Oct 1;106(14):1777-82
12356629
Biochem Biophys Res Commun. 1992 Sep 16;187(2):584-9
1382417
Rheumatol Int. 2009 Aug;29(10):1223-9
19048256
Int J Cardiol. 1992 Apr;35(1):116-8
1563867
Curr Opin Rheumatol. 2008 Nov;20(6):692-6
18946330
Ann Intern Med. 1978 Dec;89(6):881-7
717985
Rheum Dis Clin North Am. 2003 May;29(2):315-33
12841297
Blood Purif. 2007;25(4):309-15
17643057
QJM. 2007 Aug;100(8):485-94
17601770
Clin Nephrol. 2008 Aug;70(2):183-5
18793540
Medicine (Baltimore). 1974 Jan;53(1):1-46
4808710
Scand J Rheumatol. 2009;38(4):295-8
19214870
Clin Rheumatol. 2010 Jul;29(7):729-37
20174989
Arthritis Rheum. 1998 Sep;41(9):1613-9
9751093
Arthritis Rheum. 1996 Jun;39(6):1030-4
8651967
Am J Kidney Dis. 1997 Aug;30(2):279-81
9261042
Ann Rheum Dis. 2002 Aug;61(8):682-6
12117672
Am J Med. 1996 Dec;101(6):576-83
9003103
Clin Exp Rheumatol. 2007 Sep-Oct;25(5):722-7
18078620
Arthritis Rheum. 2008 Jan;58(1):15-25
18163481
J Rheumatol. 2010 Mar;37(3):603-7
20080908
Clin Rheumatol. 2009 Aug;28(8):955-9
19437088
Ann Rheum Dis. 2008 Jan;67(1):110-6
17557890
N Engl J Med. 2004 Sep 23;351(13):1285-95
15385655
Ann Rheum Dis. 2007 Jul;66(7):940-4
17329309
Ann Rheum Dis. 1992 Mar;51(3):384-8
1575587
J Rheumatol. 2003 Jul;30(7):1616-20
12858467
J Hypertens. 2006 Nov;24(11):2263-70
17053549
J Rheumatol. 1994 May;21(5):864-70
8064727
Am J Kidney Dis. 1999 Apr;33(4):e3
10196034
Ann Rheum Dis. 2002 Feb;61(2):183-4
11796412
Clin Nephrol. 2005 Nov;64(5):352-7
16312262