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Antiphospholipid syndrome — SCE Rheumatology MCQ

Instant feedback + full explanation. One question, done properly.

HardConnective tissue diseasesAntiphospholipid syndromeSCE Rheumatology

Four months after a correctly treated scleroderma renal crisis, a patient remains dialysis-dependent. Blood pressure is controlled on an ACE inhibitor and there is no urgent transplant indication. Which plan best reflects current BSR guidance?

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

Reveal the answer and explanation

Correct answer: A — Continue ACE inhibition and renal replacement therapy, reassessing recovery before transplant referral after 12 months

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

B is correct. Renal recovery after scleroderma renal crisis may be delayed, so dialysis dependence at four months is not proof of irreversible kidney failure. ACE inhibition is continued alongside appropriate renal replacement therapy. BSR advises that transplant referral may be considered after 12 months when there are no features suggesting significant recovery. A removes the treatment associated with renal-crisis survival. C moves to transplantation prematurely. D substitutes an ARB without an ACE-inhibitor intolerance. E assigns routine plasma exchange a role unsupported for uncomplicated persistent dialysis dependence.

Reference: BSR 2024 guideline for management of systemic sclerosis: https://academic.oup.com/rheumatology/article/63/11/2956/7750184