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July 24, 1981

Sign of scleroderma kidney

JAMA. 1981;246(4):324. doi:10.1001/jama.1981.03320040008008

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So-called scleroderma kidney is a life-threatening condition that affects about one tenth of patients with progressive systemic sclerosis.

It is marked by sudden development of arterial hypertension that often is followed by rapidly progressing oliguric kidney failure. Early treatment is essential, but it has been difficult to determine which patients are at risk.

One warning sign, according to a group from the University of Pittsburgh School of Medicine, is a rapidly increasing "total skin score"—an assessment of skin thickness in 26 areas of the body—in patients not suffering from renal involvement at the onset.

Virginia Steen, MD, an assistant professor of medicine, told a session of the American Rheumatism Association meeting in Boston that she and colleagues studied the signs and laboratory findings in 426 consecutive new patients with progressive systemic sclerosis seen between 1972 and 1980. Kidney involvement (not counting mild hypertension or proteinuria alone) occurred in 11% (46