A 45-year-old woman with diffuse cutaneous systemic sclerosis (dcSSc) develops acute hypertensive crisis with BP 190/110 mmHg, headache and rising creatinine. Urinalysis shows proteinuria and microscopic haematuria. This complication is best managed with:

• A High-dose corticosteroids
• B Calcium channel blockers (nifedipine)
• C Diuretics and hydralazine
• D ACE inhibitors (captopril), even if dialysis is required ✓

Explanation

Scleroderma renal crisis (SRC) is a life-threatening complication of dcSSc characterized by acute hypertension and microangiopathic renal failure. ACE inhibitors, particularly captopril, are the cornerstone of treatment because the pathophysiology involves renin-angiotensin activation from vascular endothelial injury. ACE inhibitors should be used even if the patient requires dialysis, as some recover renal function. Corticosteroids are actually a risk factor for precipitating SRC and should be used cautiously in dcSSc.

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

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Written and medically reviewed by the StethoPrep medical team.