Original article doi:10.1093/rheumatology/ker271 Scleroderma renal crisis: a retrospective multicentre study on 91 patients and 427 controls

Objective. Scleroderma renal crisis (SRC) is a severe manifestation of SSc, whose prognosis remains severe, despite treatment with angiotensin-converting-enzyme inhibitor and dialysis. This study was under-taken to describe SRC characteristics, prognosis and outcome, and evaluate the responsibility of CSs in its occurrence. Methods. Analysis concerned 91 SSc patients with SRC who were compared with 427 non-SRCSSc patients taken as controls. Results. Among the 91 SRC patients, 71 (78.0%) had high blood pressure, 53 (58.2%) hypertensive encephalopathy and 51 (56.0%) thrombotic microangiopathy; 64 (70.3%) had received CSs before or concomitantly with SRC vs 156 (36.5%) non-SRCSSc patients (P< 0.001). Treated SRC patients also received more prednisone 29.3 (28.4) vs 3.6 (9.9) mg than controls (P< 0.001). SRC clinical outcomes were poor: 49 (53.8%) patients required dialysis, which was definitive for 38. Thirty-seven (40.7%) SRC patients died vs 10.8 % of the controls (P< 0.001). Death was most frequent among dialysed patients who never recovered renal function (22 vs 2) and 13 never-dialysed SRC patients died. Conclusions. Although SRC prognosis has improved markedly, SRC remains a severe manifestation of SSc, despite treatment with angiotensin-converting enzyme inhibitor and dialysis. CSs contributed signifi-cantly to SRC occurrence. Key words: systemic sclerosis, renal crisis, angiotensin-converting enzyme inhibitor, steroids