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The kidney in progressive systemic sclerosis: a prospective study

M T Kovalchik, S J Guggenheim, M H Silverman

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    Systemic sclerosis can cause preclinical kidney damage, even in normotensive patients. Elevated plasma renin activity during cold pressor testing may indicate early renal vascular involvement in scleroderma.

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    Area of Science:

    • Nephrology
    • Rheumatology
    • Immunology

    Background:

    • Systemic sclerosis (SSc) is an autoimmune disease characterized by fibrosis and vascular abnormalities.
    • Renal involvement in SSc, known as scleroderma renal crisis, typically presents with hypertension.
    • Early detection of renal involvement in normotensive SSc patients is crucial for timely intervention.

    Purpose of the Study:

    • To investigate the presence of renal vascular abnormalities in normotensive SSc patients.
    • To assess the correlation between plasma renin activity and renal vascular lesions.
    • To identify potential biomarkers for preclinical renal involvement in SSc.

    Main Methods:

    • Renal biopsy was performed on nine normotensive SSc patients with normal renal function.
    • Vascular abnormalities were graded as prominent, mild, or normal.
    • Plasma renin activity was measured at baseline and in response to cold pressor testing.

    Main Results:

    • Vascular deposits of C3 were found in all biopsy specimens.
    • Prominent vascular abnormalities were observed in four patients, mild in two, and normal in three.
    • Elevated plasma renin activity was more frequent in patients with prominent vascular lesions.
    • A significant rise in plasma renin activity during cold pressor testing was noted in patients with vascular abnormalities.

    Conclusions:

    • Renal vascular lesions can exist in normotensive SSc patients.
    • Increased plasma renin activity, particularly in response to cold stress, suggests preclinical renal involvement in SSc.
    • Cold pressor testing may aid in identifying early renal changes in SSc.