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Scleroderma renal crisis — SCE Acute Medicine MCQ

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HardAcute Rheumatological and Dermatological EmergenciesScleroderma renal crisisSCE Acute Medicine

A 50-year-old woman with diffuse systemic sclerosis has BP 218/124 mmHg, creatinine rising from 74 to 210 micromol/L, thrombocytopenia and schistocytes. What disease-specific treatment should begin despite the acute rise in creatinine?

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

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Correct answer: D — Rapidly titrated ACE inhibition, commonly using short-acting captopril

Explanation lettering: E = shown as C · C = shown as E

D is correct. This is scleroderma renal crisis. Start an ACE inhibitor immediately and titrate rapidly toward blood-pressure control; short-acting captopril is often used when haemodynamics are changing. Creatinine may continue to rise and dialysis may be required, but ACE inhibition should generally continue because it markedly improves survival and renal recovery. High-dose glucocorticoids increase crisis risk, plasma exchange is reserved for a convincing alternative thrombotic microangiopathy, and beta-blockade or diuresis alone does not suppress the pathogenic renin–angiotensin drive.

Reference: https://pmc.ncbi.nlm.nih.gov/articles/PMC11534099/