Captopril in the Treatment of Scleroderma Renal Crisis

Thurm, Richard H.; Alexander, John C.

doi:10.1001/archinte.1984.00350160083015

Cited by 55 publications

(14 citation statements)

References 13 publications

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“…The prognosis of SRC has improved greatly with the use of ACE inhibitors [37,38]. Although mortality remains high with SSc, recent studies have shown a significant improvement in 10-year survival and a change in causes of death [3].…”

Section: Prognosismentioning

confidence: 99%

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The Scleroderma Kidney: Progress in Risk Factors, Therapy, and Prevention

Bussone¹,

Bérezné²,

Pestre³

et al. 2010

Curr Rheumatol Rep

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Scleroderma renal crisis (SRC) is characterized by malignant hypertension, oliguric/anuric acute renal failure, and important mortality, with a 5-year survival rate of 65%. SRC occurs in 2% to 5% of patients with systemic sclerosis (SSc), particularly those with diffuse cutaneous SSc in the first years of disease evolution. Several retrospective studies have found high-dose corticosteroid therapy to be associated with increased risk of SRC, and anti-RNA-polymerase III antibodies have been detected in one third of patients with SRC. Treatment relies on the early control of blood pressure with increasing doses of angiotensin-converting enzyme inhibitors, eventually associated with calcium channel blockers together with dialysis if necessary. After 2 years on dialysis, eligible patients should be considered for renal transplantation. The strategy for prevention of SRC lacks consensus. However, corticosteroids and/or nephrotoxic drugs should be avoided in patients with diffuse cutaneous SSc.

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Section: Prognosismentioning

confidence: 99%

“…Only ACE inhibitors have demonstrated efficacy in the treatment of SRC, with improved prognosis [37,38]. Captopril has been used for a large number of patients with SSc and SRC.…”

Section: Curative Treatmentmentioning

confidence: 99%

The Scleroderma Kidney: Progress in Risk Factors, Therapy, and Prevention

Bussone¹,

Bérezné²,

Pestre³

et al. 2010

Curr Rheumatol Rep

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“…Systemic manifestations included Raynaud's phenomenon, calcinosis, sclerodactyly, skin thickening, esophageal dysmotility, and telangiectasias. The renal pathology demonstrates intimal edema and proliferation of interlobular and arcuate arteries, as well as fibrinoid necrosis of smaller arteries and arterioles (2)(3)(4)(5). These pathologic changes are similar to those seen in hemolytic-uremic syndrome (HUS), malignant hypertension, and eclampsia.…”

Section: Recovery From Esrdmentioning

confidence: 72%

“…More recently, the development of the ACE inhibitors has made the greatest impact on the treatment of this syndrome (2,(4)(5)(6)(10)(11)(12). One series demonstrated a one-year survival of 76% with the use of ACE inhibitors (1 1).…”

Section: Recovery From Esrdmentioning

confidence: 99%

Scleroderma Renal Crisis and Recovery from End‐Stage Renal Disease

Fenves

Murphy

Emmett

1998

Seminars in Dialysis

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A 32-year-old African American woman, AW, presented with severe hypertension and acute renal failure. The patient had a four-year history of labile hypertension but was currently without medication. She described a 40-lb weight loss over the previous six months and for two months she had persistent anorexia, nausea, and fatigue.Admission physical examination was remarkable for a blood pressure of 210/160. Funduscopic examination showed a single left retinal flame hemorrhage and bilateral diffuse arteriolar narrowing. Additionally, she had periorbital edema and a faint rash on her eyelids. She had palpable hepatomegaly and sclerodactyly of her fingers. The remainder of her examination was normal.Admission laboratory revealed a blood urea nitrogen of 36 mgldL, a serum creatinine of 4.2 mg/dL, and mildly elevated liver function tests. Urinalysis showed microscopic hematuria and granular casts. A renal sonogram showed normal-sized kidneys with increased echogenicity.Over several days, the patient's serum creatinine rose to 10.0 mg/dL. Elective percutaneous renal biopsy revealed normal glomeruli and fibrinoid necrosis of the renal arterioles, consistent with malignant hypertension. Additional laboratory evaluation was remarkable for a positive antinuclear antibody (ANA) with a titer greater than 1:4,096 in a nucleolar pattern.Anti-DNA antibodies were negative and the C3, C4, CH.50, and serum protein electrophoresis were normal. A presumptive diagnosis of malignant hypertension secondary to scleroderma renal crisis was considered.Treatment consisted of strict blood pressure control using oral captopril and clonidine. Progressively, she became uremic and hemodialysis was initiated. A permanent vascular access

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“…Lopez-Ovejero et al [35] described the first two cases of SRC successfully treated with ACE inhibitors as monotherapy after failing to respond to other antihypertensive drugs. More reports of the successful use of captopril for the treatment of SRC followed [36][37][38]. Not only did ACE inhibitor treatment halt progression of renal failure in some patients, but it reversed the process with a return of creatinine to baseline levels in some cases [10,36].…”

Section: Treatmentmentioning

confidence: 99%

Scleroderma renal crisis: New insights and developments

Rhew¹,

Barr

2004

Curr Rheumatol Rep

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Scleroderma renal crisis (SRC) was once a uniformly fatal complication of systemic sclerosis (SSc). With the introduction of angiotensin-converting enzyme inhibitors as treatment, outcomes have improved significantly, though 39% to 50% of SSc patients who develop SRC continue to have poor outcomes, including permanent dialysis and death. Early recognition and treatment with angiotensin-converting enzyme inhibitors are important in the effective management of SRC, though given the continuing morbidity and mortality caused by SRC, they are clearly not sufficient. Newer therapies based on the pathophysiologic mechanisms underlying the development and perpetuation of SRC are needed. This article reviews the epidemiology, pathogenesis, risk factors, clinical features, and treatment of SRC, with an emphasis on recent insights and developments.

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Captopril in the Treatment of Scleroderma Renal Crisis

Cited by 55 publications

References 13 publications

The Scleroderma Kidney: Progress in Risk Factors, Therapy, and Prevention

The Scleroderma Kidney: Progress in Risk Factors, Therapy, and Prevention

Scleroderma Renal Crisis and Recovery from End‐Stage Renal Disease

Scleroderma renal crisis: New insights and developments

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