Renal Function in Scleroderma

Abstract

It has been known for some time that changes caused by scleroderma-progressive systemic sclerosisI0-appear not only on the skin but also in the internal organs, especially the gastro-intestinal tract, lungs, and heart. Only

Functional renal involvement in normotensive patients with progressive systemic sclerosis. impaired sodium excretion during isotonic saline infusion

“…Such a metabolic disorder is not regularly correlated with PAH clearance values, which are usually considered an early index of renal involvement in PSS (22), and might represent the first appearance of abnormal renal function in this disease.…”

The Kidney in Scleroderma

“…Evidence indicating that the renal circu lation may be affected before renal failure occurs in scleroderma was provided by Urai et al [19]. They showed significant reductions in renal plasma flow but normal glomerular filtration rates in 23 of 25 patients with sclero derma of varying severity.…”

“…The work by Vrai et al [19] demonstrating re ductions in renal plasma flow in scleroderma patients with normal glomerular filtration rates led these authors to suggest that there was vasoconstriction of the efferent arterioles. Cannon et al [1] showed reductions in renal cortical blood flow during induction of Ray naud's phenomenon and increments in flow after administration of aminophylline into the renal artery.…”

Renal Vasoactive Hormones in Scleroderma (Progressive Systemic Sclerosis)

“…While renal blood flow has been found to be reduced in PSS patients in the absence o f severe hypertension or renal failure [6], no abnormalities of the renin-angiotensin system or of the sympathetic nervous system have been reported in this situation [9,10], In the present study, the possibility that a defect of a vasodilator system might have a pathogenic role in the renal vascular abnormalities of PSS was examined. The urinary excretion rates of kallikrein and kinin and of immunoreactive prostaglandin E (iPGE) were determined under controlled sodium and potassium intakes in a group of patients that had no clinical evidence of heart failure, severe hypertension or renal failure.…”

“…and renal [5,6] circulations. Renal involvement is common in PSS and oliguric acute renal failure is the leading cause of death in this disease [5,7,8], Studies from this labora tory have shown marked depressions of renal cortical blood flow in PSS patients with renal failure [5], Reduced renal blood flow has also been documented in PSS patients in the absence of renal failure and hypertension under basal conditions [6] and during induction of Raynaud's phenomenon [5].…”