14/Friends, it's time for part 2 of this case tweetorial.
Make sure to check out #1-14 before you move on. #medtwitter #foammed
Make sure to check out #1-14 before you move on. #medtwitter #foammed
15/Based on the hypertension, proteinuria, and pathology demonstrating characteristic vascular changes on biopsy, coupled with sclerodactyly and raynaud’s, she was diagnosed with scleroderma renal crisis (SRC). Check out this illness script for scleroderma:clinicalproblemsolving.com/wp-content/upl…
16/SCR is a severe and life-threatening renal complication occurring in ~ 5-10% of patient with systemic sclerosis. It is most common in patients with diffuse cutaneous systemic sclerosis.
17/Clinical features include new onset severe hypertension, decreased GFR with anuria or oliguria, and occasionally, microangiopathic hemolytic anemia. Urinalysis often demonstrates mild proteinuria, with hematuria and cellular casts being less common.
18/What is first line treatment for SRC?
19/ACE inhibitors are the treatment of choice. SRC is a vasculopathy -->decreased renal perfusion --> upregulation of the RAAS system. ACE inhibitors inactivate this pathologic pathway reducing the blood pressure and reducing further vascular injury.
20/With an ACE inhibitor, her kidney injury and hypertension improved and she was discharged home with close rheumatology follow up.
This case was a great reminder of the need to do the exact opposite of what we do when most patients come in with an AKI - START an ACE inhibitor!
This case was a great reminder of the need to do the exact opposite of what we do when most patients come in with an AKI - START an ACE inhibitor!
21/To learn more, check out these great review articles! 
