|Kidney (Renal) Involvement (Main Menu)|
All patients with systemic sclerosis (scleroderma) should be regularly screened for kidney involvement, even if they have short duration of mild disease and normal serum creatinine.
Kidney Failure. The kidneys' main function is to eliminate excess fluid and waste material from your blood. When your kidneys lose their filtering ability, dangerous levels of fluid and waste accumulate in your body—a condition known as kidney (renal) failure. Mayo Clinic.
Kidney Failure.When both of your kidneys fail, your body holds fluid. Your blood pressure rises. Harmful wastes build up in your body. You develop fatigue, nausea, and loss of appetite. MedicineNet.com.
Kidney Pain. Pain caused by the kidneys is typically felt in the flank area, which is in the back, just at the lower edge of the ribs on either side of the spine. Pain caused by the kidneys tends to be sharp and severe, to and occur in waves. It is uncommon for the kidneys to cause dull, aching pain. People sometimes equate back pain with kidney pain, but aching pain in the back—especially the lower back or the middle of the back—is usually due to muscles, ligaments, or even vertebrae and disks in the spinal column. Net Wellness.
Glomerular Filtration Rate (GFR). Glomerular filtration rate is the best test to measure your level of kidney function and determine your stage of kidney disease. Your doctor can calculate it from the results of your blood creatinine test, your age, race, gender and other factors. National Kidney Foundation.
Autoimmune Kidney Disease Kidney disease is a sneaky thing. There may be no symptoms at all for a long time while it is developing. This means that unfortunately, many people never realize they have a kidney problem until a symptom such as back pain or blood in the urine appears. About.com.
Deadly kidney disease can make a sneak attack. Unchecked, chronic kidney disease contributes to heart disease, hypertension, weak bones, nerve damage, kidney failure and death. Chicago Tribune, 02/20/2015.
Scleroderma Renal Crisis
The systemic forms of scleroderma can cause renal (kidney) problems.
Kidney involvement is the most serious and life threatening complication, so close monitoring of kidney function is necessary. Reduction in kidney function is often accompanied by high blood pressure. Current drugs of choice to treat kidney disease associated with scleroderma are ACE inhibitors such as Captopril or enalapril. Other drugs to reduce blood pressure have also been used with some success.
New Study Summarizes Scientific Findings Concerning Scleroderma Renal Crisis (SRC). SRC is still affecting a meaningful population of patients with systemic sclerosis, so a vigilant diagnosis and therapy is needed to prevent adverse outcomes and enhance survival. Seminars in Arthritis and Rheumatism, 02/27/2015.
Case Report: Scleroderma renal crisis in a newly diagnosed mixed connective tissue disease (MCTD) resulting in dialysis-dependent chronic kidney disease despite angiotensin-converting enzyme inhibition. A case of MCTD consisting of scleroderma, Sjögren's syndrome and polymyositis complicated by scleroderma renal crisis (SRC) but with negative anti-nuclear antibody (ANA), anti-Scl 70 and anti-centromere antibodies. Springer Link, May 2013;58:153 (Also see Mixed Connective Tissue Disease)
Renal involvement in autoimmune connective tissue diseases. Patients with scleroderma renal crisis (SRC) show a significant benefit of early angiotensin-converting-enzyme (ACE) inhibitor use in particular and strict blood pressure control in general. PubMed, BMC Med, 2013 Apr 4;11:95.
Cautious ACE Inhibitor Use Needed in Scleroderma. This study suggests that ACE inhibitors should be used with great caution in patients with scleroderma, particularly early in disease when the risk of renal crisis is greatest. MedPageToday. 11/11/12. (Also see Medication Warnings, and Hypertension)
Treatment of Systemic Sclerosis Complications: What to Use When First-Line Treatment Fails—A Consensus of Systemic Sclerosis Experts. Symptoms treatment recommendations by over 100 scleroderma experts, for scleroderma renal crisis (SRC), digital ulcers (DU), pulmonary hypertension (PAH/PH), reflux, skin involvement, and arthritis. Seminars in Arthritis and Rheumatism Volume 42, Issue 1 , Pages 42-55, August 2012. (Also see Digital Ulcers, Pulmonary Hypertension, Reflux, Skin Involvement, Skeletal Involvement, Scleroderma Treatments, and Dr. Janet Pope)
Corticosteroids and the risk of scleroderma renal crisis: a systematic review. Great caution must continue to be exerted when initiating such therapy, especially in high doses and in the early diffuse subset of SSc patients. Rheumatol Int. (Also see Steroid Warnings for Scleroderma)
(Case Report) An unusual cause of acute renal failure in systemic sclerosis. The patient's renal failure improved on an oxalate free diet. PubMed, Ann Rheum Dis.
Renal Failure Prevention and Treatments
Corticosteroids strongly increase the short-term risk of developing scleroderma renal crisis!
End-stage kidney disease due to scleroderma—outcomes in 127 consecutive ANZDATA. registry cases. Scleroderma is an uncommon cause of end-stage kidney disease (ESKD) which carries significant morbidity and mortality risks. Five year deceased donor and live donor renal allograft survival rates of recipients with scleroderma were 53 and 100%, respectively. Brian Siva, Nephrol. Dial. Transplant (2011) February 28, 2011.
Renal disease in systemic sclerosis with normal serum Creatinine. Patients with systemic sclerosis should be screened for renal involvement irrespective of disease severity or duration. Clinical Rheumatology. (Also see Pulmonary Hypertension)
Prognosis of scleroderma renal crisis: a long-term observational study. Short-term prognosis of SRC has improved, but long-term prognosis remains disappointing. Plasma exchange (PEx) in addition to ACE inhibitors seems to be a therapeutic option in patients with SRC who develop micro-angiopathy or are intolerant to high doses of ACE inhibitors. Nephrol. Dial. Transplant, 2012.
ACE Inhibitors (Angiotensin-Converting Enzyme Inhibitors)
Scleroderma Renal Crisis (SRC): A Rare but Severe Complication of Systemic Sclerosis. The prognosis of SRC has dramatically improved with the introduction of angiotensin-converting enzyme inhibitors (ACEi). The treatment of SRC relies on aggressive control of blood pressure with ACEi, if needed in combination with other types of antihypertensive drugs. PubMed, Clin Rev Allergy Immunol. 2009 Dec 15.
Kidney (Renal) Dialysis
Kidney (Renal) Dialysis When the kidneys fail, dialysis of some form must be instituted to take over the work of the failed kidneys. There are two types of kidney dialysis: hemodialysis and peritoneal. ISN.
Kidney (Renal) Transplant
Kidney transplantation is a surgical procedure that places a healthy, donated kidney into the patient with kidney failure. The donated kidney can perform all the functions that the patient's damaged kidneys are unable to do. Emory Transplant Center
Hypertension (High Blood Pressure)
Everyone with Diffuse Systemic Scleroderma should be measuring their blood pressure at home every day or two. If its elevated over a certain point (to be determined by your doctor) you should call your doctor immediately. CREST patients should measure their blood pressure at least once a month.
Lightheadedness and Hypertension Contrary to popular belief, high blood pressure (hypertension) itself does not cause lightheadedness. Hypertensive patients may experience lightheadedness, however, when their blood pressure drops for any reason. MedicineNet.
Ace Inhibitors are often used to control high blood pressure in Scleroderma. Calcium Channel Blockers are often used for Raynaud's or Hypertension in Scleroderma.