PT  - JOURNAL ARTICLE
AU  - Luc Mouthon
AU  - Guillaume Bussone
AU  - Alice Berezné
AU  - Laure-Hélène Noël
AU  - Loïc Guillevin
TI  - Scleroderma Renal Crisis
AID  - 10.3899/jrheum.131210
DP  - 2014 May 15
TA  - The Journal of Rheumatology
PG  - jrheum.131210
4099  - http://www.jrheum.org/content/early/2014/05/12/jrheum.131210.short
4100  - http://www.jrheum.org/content/early/2014/05/12/jrheum.131210.full
AB  - Scleroderma renal crisis (SRC) is characterized by malignant hypertension and oligo-anuric acute renal failure. It occurs in 5% of patients with systemic sclerosis (SSc), particularly in patients with diffuse disease during the first years. SRC is more common in patients receiving corticosteroids, the risk increasing with increasing dose. The disease is sometimes triggered by use of nephrotoxic drugs and/or intravascular volume depletion. Left ventricular insufficiency and hypertensive encephalopathy are typical clinical features. Thrombotic microangiopathy is detected in 43% of cases, and anti-RNA-polymerase III antibodies are present in one-third of patients. Renal biopsy is not necessary if SRC presents classical features. However, biopsy may help to define the prognosis and guide treatment in atypical forms. The prognosis of SRC has greatly improved with the introduction of angiotensin-converting enzyme (ACE) inhibitors. However, the 5-year survival for SSc patients with full SRC remains low (65%). The treatment of SRC relies on aggressive blood pressure control with an ACE inhibitor, combined with other antihypertensive drugs if needed. Dialysis is frequently indicated but can be stopped in about half of patients, mainly those with good blood pressure control. Patients who need dialysis for more than 2 years qualify for renal transplantation.