Title
Renal Crisis as the Initial Manifestation of Scleroderma
Authors
Ronak Gandhi, Aparna Das, Daniel Gonzalez, Vijaya Murthy
Journal
Cureus
Abstract:
We report the case of a young Hispanic woman who was originally admitted to the emergency department following hypertensive urgency and right-sided blurry vision. The patient did not carry a diagnosis of scleroderma at the time of the visit. However, upon further evaluation, the patient was found to have a scleroderma renal crisis. An angiotensin-converting enzyme (ACE) inhibitor was initiated promptly with subsequent normalization of the blood pressure and creatinine level. Scleroderma renal crisis is a rare, highly feared complication of scleroderma that if left untreated can be life-threatening. Therefore, it is important to identify this condition early and initiate therapy without delay.
Conclusion:
Although renal complications can occur following the onset of dcSSc, it commonly takes a few years before a patient’s renal injury advances to SRC. However, as evidenced by this case, it is important to keep SRC on the differential even if the patient is without a known history of systemic sclerosis. Patients with severe hypertension, especially those with associated multisystem complications, can require extensive workup to determine the underlying etiology. Given its life-threatening nature, clinicians should have a low threshold for diagnosing SRC in the setting of renal manifestations and elevated blood pressure, and a rapid yet decisive treatment plan should be initiated.