Scleroderma renal crisis with minimal skin involvement and no serologic evidence of systemic sclerosis

We describe a 75-year-old male patient who developed end-stage renal failure secondary to scleroderma renal crisis. The patient had cutaneous involvement limited to his fingers and feet, and had repeatedly negative serologic tests for antinuclear antibodies. This case illustrates that scleroderma renal crisis should be considered in the differential diagnosis of unexplained acute renal failure in patients with suspected systemic sclerosis, even if they lack the typical extensive cutaneous changes and the expected serologic findings.