SRC - risk factors

Q: Maintenance of high-dose steroid therapy in scleroderma patients prevents Scleroderma Renal Crisis (SRC).

A) True

B) False

Answer: B

The use of glucocorticoids, particularly high doses, may lead to SRC. High-dose glucocorticoid causes salt and volume retention, the causation or worsening of hypertension, and so become a precursor of SRC.

Other major clinical risk factors are 

• contractures of large joints
• new-onset anemia
• new heart failure 
• development of pericardial effusion 

#rheumatology

#nephrology

References:

1. Kohno K, Katayama T, Majima K, et al. A case of normotensive scleroderma renal crisis after high-dose methylprednisolone treatment. Clin Nephrol 2000; 53:479.

2. Steen VD, Medsger TA Jr. Case-control study of corticosteroids and other drugs that either precipitate or protect from the development of scleroderma renal crisis. Arthritis Rheum 1998; 41:1613.

3. Steen VD, Medsger TA Jr, Osial TA Jr, et al. Factors predicting development of renal involvement in progressive systemic sclerosis. Am J Med 1984; 76:779.

4. Gordon SM, Stitt RS, Nee R, et al. Risk Factors for Future Scleroderma Renal Crisis at Systemic Sclerosis Diagnosis. J Rheumatol 2019; 46:85.