Reversal of Scleroderma Renal Crisis for More Than Two Years in a Patient Treated with Captopril
✍ Scribed by Leif B. Sorensen; Kathryn Paunicka; Max Harris
- Publisher
- John Wiley and Sons
- Year
- 1983
- Tongue
- English
- Weight
- 380 KB
- Volume
- 26
- Category
- Article
- ISSN
- 0004-3591
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✦ Synopsis
Scleroderma renal crisis is perhaps the most dreaded manifestation of scleroderma. Until recently this complication was regarded as invariably fatal within 3 months after its onset. In the late 1970s isolated case reports suggesting that aggressive antihypertensive treatment may successfully control hypertension and lead to varying degrees of reversal of renal failure began to appear (1.2). However, long term survival is still uncommon (3-5). Eight of 9 scleroderma patients in renal crisis seen at the University of California Los Angeles (UCLA) Medical Center between June 1975 and December 1978 died within an average of 71 days after the onset of renal crisis in spite of intensive therapy with all available and several experimental antihypertensive medications and with intensive dialysis (5).
The availability of captopril, a potent inhibitor of the angiotensin converting enzyme, represents an important addition to the therapeutic resources for patients with scleroderma renal crisis, who as a rule have markedly elevated levels of plasma renin activity (43). Several cases of successful treatment of renal crisis with captopril (5-10) have been tempered by lack of response in others (5,7,9). The clinical course of 7 patients with malignant hypertension and renal