WCN26-2918 A Case of Peritoneal Dialysis Following Scleroderma Renal Crisis

Introduction: Scleroderma renal crisis (SRC) is a severe complication of systemic sclerosis, and some patients require renal replacement therapy.We report a case of end-stage renal disease secondary to SRC that necessitated initiation of peritoneal dialysis (PD).Methods: A 77-year-old woman presented on day X with edema, fatigue, and rapidly progressive renal dysfunction.One month earlier, finger edema had been noted at a previous hospital.On arrival, there was no overt generalized edema, but she exhibited skin sclerosis of the fingers and an ulcer of the right third proximal interphalangeal (PIP) joint.Her blood pressure was 198/77 mmHg.Based on the findings of newly developed hypertension, elevated anti-RNA polymerase III antibody (100 Index), markedly increased plasma renin activity (51.2 ng/mL/hr), aldosterone (111.0 pg/mL), and acute kidney injury, she was diagnosed with scleroderma renal crisis (SRC) and admitted.Serum creatinine was 10 mg/dL on admission, compared to 0.76 mg/dL approximately one year earlier.Emergency hemodialysis was initiated, and an ACE inhibitor was started with a target systolic blood pressure (sBP) of around 130 mmHg.Results: Despite gradual up-titration of the ACE inhibitor, blood pressure remained difficult to control, with sBP persistently around 170 mmHg.A calcium channel blocker was added on day X + 4, and dose escalation eventually achieved the target blood pressure.However, renal function did not improve, and maintenance dialysis became necessary.Because systemic sclerosis-related vascular compromise raised concerns that hemodialysis might worsen the digital ulcer, PD was selected.PD was initiated on day X + 32, and her subsequent course was favorable.Conclusion: At the time of dialysis initiation, the patient's ownership of multiple cats posed an infection-control concern.Although PD is generally discouraged in cat owners, hemodialysis was not feasible in this case, and PD was selected.This is a rare and instructive case of SRC progressing to end-stage renal disease requiring PD.I have no potential conflict of interest to disclose.I did not use generative AI and AI-assisted technologies in the writing process.