Kidney involvement in systemic sclerosis: From pathogenesis to treatment

Abstract

Among all possible systemic sclerosis internal organ complications, kidney involvement is frequently neglected or underestimated, except for the life-threatening scleroderma renal crisis. Fortunately, this severe clinical presentation is nowadays better controlled with available treatments, in particular angiotensin-converting enzyme inhibitors, and this has led to a reduction in its short-and longer-term mortality. Pathogenetic determinants are not well understood and many different other kidney involvements are possible in systemic sclerosis, including proteinuria, albuminuria, reduction of renal filtration, autoantibodies-related glomerulonephritis, and drug-related side effects. Different serological and radiological methods of evaluations are nowadays available, some representing promising diagnostic tool and prognostic outcome measure. Except for angiotensin-converting enzyme inhibitors in scleroderma renal crisis, no other treatment is currently recommended for treatment of kidney involvement in systemic sclerosis. For this reason, further studies are necessary to investigate its prognostic impact, in particular in combination with other systemic sclerosis-related internal organ manifestations. This review summarizes current available literature on kidney involvement in systemic sclerosis.

Scleroderma renal crisis following Covid-19 infection

“…The incidence of renal crisis in SSc is 2%–3% and usually occurs in the first 5 years from disease onset in diffuse-SSc patients with anti-topoisomerase 1 (ATA) or RNA polymerase 3 antibodies. 1 Other risk factors for SRC are pericardial effusion, tendon friction rub, and steroid use. The patient presented herein did not have risk factors for SRC.…”

What Role Does Trabecular Bone Score Play in Chronic Inflammatory Rheumatic Diseases?

“…SSc is a connective tissue disease characterized by early microvascular impairment, skin, and internal organ fibrosis (19)(20)(21)(22)(23)(24)(25)(26). Several studies have also recently demonstrated an increased risk of OP in SSc patients, correlated with multiple factors, i.e., low vitamin D levels (1,5,13,15,27).…”

The Treatment of Lung Involvement in Systemic Sclerosis

“…Moreover, high-resolution computed tomography (HRCT) evidences interstitial abnormalities in 90% of SSc patients [7], and pulmonary function tests (PFT) showed alterations in 40-75% [8]. There has been no significant change in SSc mortality rate over the past 40 years [9,10], although an increase in mortality due to ILD and PAH [11,12] is significant, a decrease in deaths due to renal crisis has been recorded [13]. Nowadays, ILD and PAH are the two leading causes of death in SSc, accounting for 33% and 28% of deaths, respectively [10][11][12].…”