Article
New data on scleroderma renal crisis and predictive factors from more than 3000 patients
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Published: | September 1, 2015 |
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Introduction: Renal crisis is rare but still a medical emergency in patients with SSc. To improve detection and follow-up of patients with SSc, the German Network for Systemic Scleroderma (DNSS) was founded 2003, including more than 40 medical centers.
Methods: More than 3000 patients have been grouped into four disease subsets, i.e. limited cutaneous disease (lcSSc), diffuse cutaneous disease (dcSSc), overlap-syndrome and undifferentiated connective tissue disease (UCTD) with scleroderma features.
This analysis has focused on renal crisis within the three main subsets, e.g. lcSSc, dcSSc and overlap-syndromes. The aim was to identify baseline aspects, which are associated with a higher risk for future SSc-associated renal crisis.
Results: Recent analyses of up to now 3180 patients revealed that 56% of patients suffer from lcSSc, 34% from dcSSc and 11% of patients were diagnosed with an overlap-syndrome. Eighteen patients suffered from a renal crisis (1.4%), while 10% were classified with kidney involvement and 8% diagnosed with proteinuria. Of these, 66.7% had dcSSc, while just 27.8% were diagnosed with lcSSc and 5.6% with overlap syndromes.
Predictive factors for renal crisis included dcSSc (odds ratio (OR) 4.6, p=0.005, 95%-confidence interval (CI) 1.6-13.5), a modified Rodnan skin score of more than 15 (OR 4.7; p=0.002, 95%-CI 1.7-13), positive anti-RNA-polymerase autoantibodies (RNAP) (OR 24.6, p<0.0001, 95%-CI 6.1-99.5), tendon friction rubs (OR 5.4, p=0.004, 95%-CI 1.7-16.9), hypertension (OR 6.1, p<0.0001, 95%-CI 2.3-16.5), proteinuria (OR 11.8, p<0.0001, 95%-CI 4.3-32.1) and elevated CK-levels (OR 5.1, p=0.01, 95%-CI 1.4-18.9). Interestingly, positive anti-topoisomerase autoantibodies did not predict a higher risk for renal crisis. Significantly more patients with renal crisis were started on ACE-inhibitors (61.1%, 11/18, p=0.001). Of these, 5 patients also suffered from proteinuria and 7 patients from hypertension. Patients on systemic glucocorticoids had also an increased risk to develop a renal crisis (OR 5.1, p=0.002, 95%-CI 1.8-14.3), independent which dosage was administered (> or < 7.5mg/day).
Conclusion: Renal crisis has become a rare complication in SSc. The highest risk included positive RNAP antibodies, followed by proteinuria, hypertension, tendon friction rubs, elevated CK-levels and a skin score above 15. Consequently, close monitoring of patients at high risk for SSc associated renal crisis is mandatory.