A 40-year-old woman with diffuse cutaneous systemic sclerosis develops a sudden rise in blood pressure (220/120 mmHg) and acute kidney injury (creatinine 4.5 mg/dL) with microangiopathic hemolytic anemia. This complication is called scleroderma renal crisis. The FIRST-LINE treatment is:
- A ACE inhibitor (captopril) started urgently and titrated to BP control ✓
- B Sodium nitroprusside intravenous infusion
- C Corticosteroids (methylprednisolone) plus plasma exchange
- D Labetalol intravenous infusion
Correct answer: A. ACE inhibitor (captopril) started urgently and titrated to BP control
Explanation
Scleroderma renal crisis is a medical emergency defined by malignant hypertension and rapidly progressive AKI. ACE inhibitors (captopril is preferred for rapid oral titration; alternatively IV enalaprilat) are the cornerstone of treatment and have dramatically improved outcomes. Unlike other causes of hypertensive emergency, ARBs are not equivalent in this context. High-dose corticosteroids are a risk factor for precipitating scleroderma renal crisis and should be avoided.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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Written and medically reviewed by the StethoPrep medical team.