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Scleroderma renal crisis — SCE Acute Medicine MCQ

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HardAcute Rheumatological EmergenciesScleroderma renal crisisSCE Acute Medicine

A 49-year-old woman with diffuse systemic sclerosis presents with headache and blurred vision. Blood pressure is 226/118 mmHg, creatinine has risen to 280 micromol/L and urinalysis shows mild protein but little blood. She recently started prednisolone 40 mg daily for arthralgia. What is the most appropriate next step in management?

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Correct answer: E — Start an ACE inhibitor urgently and involve renal specialists

New malignant hypertension and AKI in diffuse systemic sclerosis, especially after high-dose steroids, suggests scleroderma renal crisis. ACE inhibitors are the key immediate therapy despite renal impairment. Further steroids can worsen the crisis. The pearl is that relatively bland urine with severe hypertension is an important clue.

Reference: BSR systemic sclerosis guideline; EULAR recommendations