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Systemic sclerosis renal crisis — RCPSC IM MCQ

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HardRheumatologySystemic sclerosis renal crisisRCPSC IM

A 46-year-old woman with diffuse cutaneous systemic sclerosis develops abrupt headache and blurred vision. Blood pressure is 214/118 mmHg, creatinine rises from 72 to 185 micromol/L and urinalysis shows mild proteinuria. Platelets are 88 x 10^9/L with schistocytes on smear. What is the most appropriate management?

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Correct answer: E — Start an ACE inhibitor urgently and admit for blood pressure control

Scleroderma renal crisis presents with malignant hypertension, AKI and microangiopathic hemolysis. ACE inhibitor therapy should be started urgently despite elevated creatinine.

Reference: Canadian Rheumatology Association systemic sclerosis resources