A 42-year-old woman with diffuse cutaneous systemic sclerosis of two years' duration presents with headache, blood pressure of 200/120 mmHg, rapidly rising creatinine and microangiopathic haemolysis. The single most important therapeutic intervention is:

• A Intravenous methylprednisolone pulse
• B Plasma exchange
• C An angiotensin-converting enzyme inhibitor ✓
• D Nifedipine

Explanation

This is scleroderma renal crisis, occurring typically within the first few years of diffuse disease. Prompt treatment with an ACE inhibitor such as captopril dramatically improves survival and preserves renal function even when creatinine is high. Corticosteroids above moderate doses are a recognised precipitant of renal crisis, nifedipine treats Raynaud phenomenon rather than the crisis, and plasma exchange has no established role.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.