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Scleroderma renal crisis — RCPSC IM MCQ

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HardRheumatologyScleroderma renal crisisRCPSC IM

A 48-year-old woman with diffuse cutaneous systemic sclerosis develops abrupt headache and visual blurring. Blood pressure is 214/118 mm Hg, creatinine has risen from 70 to 196 umol/L, urinalysis has mild protein and few red cells, and the smear shows schistocytes. She recently received prednisone 40 mg daily for inflammatory arthralgia. What is the most likely cause?

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Correct answer: A — Scleroderma renal crisis precipitated by glucocorticoid exposure

Diffuse systemic sclerosis with abrupt severe hypertension, acute kidney injury and microangiopathic hemolysis indicates scleroderma renal crisis. Moderate or high-dose glucocorticoids increase risk.

Reference: Canadian Rheumatology Association resources; EULAR systemic sclerosis guidance