The scleroderma kidney: progress in risk factors, therapy, and prevention

Scleroderma renal crisis (Src) is characterized by malignant hypertension, oliguric/anuric acute renal failure, and important mortality, with a 5-year survival rate of 65%. Src occurs in 2% to 5% of patients with systemic sclerosis (SSc), particularly those with diffuse cutaneous SSc in the first years of disease evolution. Several retrospective studies have found high-dose corticosteroid therapy to be associated with increased risk of Src, and anti-RNA-polymerase III Antibodies have been detected in one third of patients with Src. Treatment relies on the early control of blood pressure with increasing doses of angiotensin-converting Enzyme inhibitors, eventually associated with Calcium Channel blockers together with dialysis if necessary. After 2 years on dialysis, eligible patients should be considered for renal transplantation. The strategy for prevention of Src lacks consensus. However, corticosteroids and/or nephrotoxic drugs should be avoided in patients with diffuse cutaneous SSc.