Scleroderma renal crisis presents with abrupt hypertension and rising creatinine, most often in early diffuse cutaneous disease and in patients with anti-RNA polymerase III antibodies. Moderate to high doses of corticosteroids are a recognised risk factor.
Patients should know to check their blood pressure at home and to report headache, visual disturbance or breathlessness. An ACE inhibitor is the treatment once renal crisis occurs.
- Check blood pressure and creatinine at every visit in early diffuse systemic sclerosis.
- Advise home blood pressure monitoring for patients at higher risk, including those with anti-RNA polymerase III antibodies.
- Avoid prednisolone above about 15 mg daily unless clearly needed.
- Treat renal crisis urgently with an ACE inhibitor.
Why it matters
Renal crisis is treatable when caught early and devastating when it is not.
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