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Scleroderma renal crisis — SCE Rheumatology MCQ

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HardConnective Tissue DiseasesScleroderma renal crisisSCE Rheumatology

A 48-year-old woman with early diffuse systemic sclerosis develops headache and blurred vision. Blood pressure is 218/116 mmHg and creatinine has risen from 64 to 176 micromol/L over 2 weeks. Urinalysis shows mild protein and a few red cells. She recently received prednisolone 40 mg for inflammatory arthritis. What is the most appropriate management?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: E — Start an ACE inhibitor urgently

Explanation lettering: D = shown as A · A = shown as B · E = shown as C · C = shown as D · B = shown as E

Start an ACE inhibitor urgently is best because scleroderma renal crisis requires urgent ACE inhibitor treatment even when creatinine is rising. A is less suitable because calcium-channel blocker alone is inadequate for renal crisis; C is less suitable because high-dose glucocorticoids are a risk factor and can worsen the syndrome; D is less suitable because renal biopsy should not delay treatment when the presentation is classic; E is less suitable because cyclophosphamide does not address the acute renin-mediated crisis. Clinical pearl: new severe hypertension in early diffuse systemic sclerosis is renal crisis until proven otherwise.

Reference: BSR systemic sclerosis guideline 2024; BNF