Scleroderma is a chronic connective tissue disease that is characterized by the hardening of the skin and connective tissues. Although scleroderma mainly affects the skin, it can also affect the function of several organs, including the heart, lungs, and kidneys to varying degrees.
Involvement of the kidneys occurs almost exclusively in patients with diffuse systemic scleroderma and is rarely seen in limited scleroderma.
Signs of kidney involvement in scleroderma
Some of the early signs of kidney involvement in scleroderma include mild to high blood pressure, the presence of protein in the urine, and blood test abnormalities.
Although uncommon, high blood pressure may worsen rapidly if not recognized and cause damage to the kidneys, leading to scleroderma renal crisis. Symptoms of scleroderma renal crisis include sudden rises in blood pressure, headache, visual disturbances, shortness of breath, chest pain, and discomfort or mental confusion.
If scleroderma renal crisis is not treated promptly, it may lead to kidney failure, a condition in which the kidneys lose their ability to eliminate waste products from the body.
How can the risk of kidney involvement be minimized?
To avoid serious kidney disease, some medications such as corticosteroids and nonsteroidal anti-inflammatory drugs (NSAIDs) should be avoided or their use should be minimized. Reducing cold exposure may also reduce the risk of kidney involvement in scleroderma patients.
How can kidney involvement be monitored?
People with scleroderma should have their blood pressure and kidney function monitored regularly. People with early diffuse systemic scleroderma are advised to use a home blood pressure monitoring device to monitor their blood pressure daily.
How is kidney disease treated?
Kidney disease in scleroderma can be treated using angiotensin-converting enzyme (ACE) inhibitors that block the production of an enzyme that narrows blood vessels. The desired effect is relaxed blood vessels and lowered blood pressure.
Some examples of ACE inhibitors used to treat kidney disease in scleroderma are enalapril, captopril, and lisinopril.
If the blood pressure can be promptly and completely controlled, kidney injury can be prevented and even reversed over time.
In cases of severe kidney failure, dialysis may be required.
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