skip to main content

Scleroderma renal crisis — SCE Rheumatology MCQ

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

HardConnective tissue diseasesScleroderma renal crisisSCE Rheumatology

A 53-year-old woman with diffuse cutaneous systemic sclerosis develops headache, blurred vision and dyspnoea. Blood pressure is 214/118 mmHg, creatinine has risen from 72 to 186 µmol/L and blood film shows fragmented red cells. She started prednisolone 40 mg daily three weeks ago for arthralgia. What is the most appropriate management?

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

Reveal the answer and explanation

Correct answer: B — Start an ACE inhibitor immediately and admit for specialist care

This is scleroderma renal crisis: abrupt hypertension, acute kidney injury and microangiopathic haemolysis, often associated with recent high-dose glucocorticoids. ACE inhibitor treatment should start urgently, even with renal impairment. Steroid escalation would be harmful and biopsy must not delay emergency blood pressure control.

Reference: BSR systemic sclerosis guideline 2024; EULAR systemic sclerosis recommendations