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Early Signs for Scleroderma Renal Crisis

Risk factors for scleroderma renal crisis (SRC) include cold exposure, steroid use, dehydration, rapid progression of skin disease, tendon friction rubs, anti-RNA polymerase III antibodies, and pregnancy. A new study examines the risk factors for developing SRC after patients are diagnosed with systemic sclerosis.

Researchers from Walter Reed National Military Medical Center in Bethesda, Maryland, retrospectively studied the records of a cohort of patients with systemic sclerosis (SSc) seen from 2005 to 2016, specifically looking at who developed SRC after SSc diagnosis.

The authors found the following factors were predictive of SRC in patients diagnosed with SSc:

  • proteinuria (P<0.001, OR 183, 95% CI 19.1–1750)
  • anemia (P=0.001, OR 9.9, 95% CI 2.7–36.2)
  • hypertension (P<0.001, OR 13.1, 95% CI 4.7–36.6)
  • chronic kidney disease (P=0.008, OR 20.7, 95% CI 2.2–190.7)
  • elevated erythrocyte sedimentation rate (P<0.001, OR 14.3, 95% CI 4.8–43.0)
  • thrombocytopenia (P=0.03, OR 7.0, 95% CI 1.2–42.7)
  • hypothyroidism (P=0.01, OR 2.8, 95% CI 1.2–6.7)
  • anti-Ro antibody seropositivity (P=0.003, OR 3.9, 95% CI 1.6–9.8)
  • anti-RNA polymerase III antibodies (P=0.02, OR 4.1, 95% CI 1.2–13.8)

Individually, the predictive value for SRC was low; however, three or more of these factors present at diagnosis was sensitive (77%) and specific (97%) for future SRC, the researchers found.

These profiles add to the current list and should be considered in new SSc patients as these patients may benefit from close observation of blood pressure, proteinuria, and other signs of renal crisis.

Jack Cush, MD, is the director of clinical rheumatology at the Baylor Research Institute and a professor of medicine and rheumatology at Baylor University Medical Center in Dallas. He is the executive editor of A version of this article first appeared on RheumNow, a news, information and commentary site dedicated to the field of rheumatology. Register to receive their free rheumatology newsletter.