Q: Which type of renal failure is treated/managed by ACE inhibitors?
Answer: Scleroderma Renal Crisis!
Scleroderma Renal Crisis is one of the few rheumatological emergencies where early diagnosis and treatment can make a big difference in outcome. A wrong diagnosis may lead to the wrong management pathway and high mortality. SRC is heralded by a hypertensive crisis associated with acute renal failure. Still, the pearl is to avoid IV Labetolol or nitroprusside and gradually decrease blood pressure with PO angiotensin-converting enzyme (ACE) inhibitors. Calcium channel blockers may help. Renal dialysis is a last resort. It has been suggested that the use of steroids is associated with the onset of scleroderma renal crisis.
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References:
1. Cole A, Ong VH, Denton CP. Renal Disease and Systemic Sclerosis: an Update on Scleroderma Renal Crisis. Clin Rev Allergy Immunol. 2023 Jun;64(3):378-391. doi: 10.1007/s12016-022-08945-x. Epub 2022 Jun 1. PMID: 35648373; PMCID: PMC10167155.
2. Hudson M, Ghossein C, Steen V. Scleroderma renal crisis. Presse Med. 2021 Apr;50(1):104063. doi: 10.1016/j.lpm.2021.104063. Epub 2021 Feb 3. PMID: 33548376.
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