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Scleroderma renal crisis — RACP Adult Medicine MCQ

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HardRheumatologyScleroderma renal crisisRACP Adult Medicine

A 42-year-old woman with diffuse systemic sclerosis develops headache and blurred vision. Blood pressure is 206/116 mmHg, creatinine has doubled in 2 weeks and blood film shows schistocytes. Urine dipstick shows mild proteinuria. What is the most appropriate management?

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Correct answer: A — Start an ACE inhibitor urgently with careful blood pressure control

Scleroderma renal crisis requires urgent ACE inhibitor therapy even when creatinine is rising, alongside close monitoring. High-dose corticosteroids can precipitate or worsen the condition. Plasma exchange alone and beta-blocker monotherapy do not address the renin-mediated crisis.

Reference: Australian Rheumatology Association guidance; AMH