In people with scleroderma, compromised kidney function can affect how well these patients can respond to aging and other causes of kidney damage, such as diabetes. In addition, kidney function can also affect the efficacy and possible toxicity of medications.
Because the kidneys remove wastes from the blood, any malfunction may cause these wastes to build in the blood and damage the body. In those with systemic scleroderma, the kidneys can be damaged due to a sudden and severe increase in blood pressure called scleroderma renal crisis (SRC).
People most at risk for this type of kidney crisis include those with:
- Early diffuse systemic sclerosis with rapid progression (66% develop SRC within 1 year of diagnosis)
- Presence of tendon friction rubs
- A history of use of high-dose corticosteroid therapy (for example, >15 mg/day of prednisone)
- Presence of RNA autoantibodies (anti-RNA polymerase III)
- New anemia, which may be an early clue to the onset of SRC
- Cardiac insufficiency, pericardial effusion, or other cardiac events may precede SRC
Sudden onset of high blood pressure (hypertension) of more than 150/85mmHg is the key symptom of renal crisis. It causes almost immediate decrease in kidney function. Symptoms to watch for are:
- Visual disturbances
- General malaise
- Changes in blood or urine chemistry
- Pulmonary edema (fluid in the lungs)