THỰC TRẠNG CỦA CƠN BÃO THẬN (SCLERODERMA RENAL CRISIS) TRÊN BỆNH NHÂN XƠ CỨNG BÌ TOÀN THỂ TẠI BỆNH VIỆN BẠCH MAI

Abstract

Objectives: Describe clinical and subclinical characteristics of scleroderma renal crisis (SRC) in patients with diffuse scleroderma and examinate some risk factors of SRC. Subjects and methods: 25 patients with diffuse scleroderma (diagnosed by Classification of ACR/EULAR 2013) and symptoms of SRC (according to ISRCS standard, excluded acute kidney injury by other causes), hospitalised at Bach Mai hospital between 2016 and 2023 are included in this study. Results: Incidence rate of SRC is 8%. Mean age when SRC onset is 60,4 ± 11,8 years old. SRC occurs in a mean 2,3 years after systemic scleroderma (SSc) was diagnosed. 58 percent of SRC patients have duration of SSc less than 1 year. 88% patients have hypertension; mean blood pressure is approximately 162 mmHg. Oedema and rising serum creatinin occur in all patients; mean serum creatinin is 466,3 ± 177,5 µmol/L. Proteinuria and hematuria are noted in almost cases (over 88%). Mortality rate is up to 64% in 6 months. There are significant differences between two groups (SRC and no-SRC, p < 0,05) about rate of anemia, pulmonary hypertension, heart failure, age over 58 years old, duration of systemic scleroderma less than 4 years, methyl-prednisolon dose over 16 mg per day, thrombocytopenia and hypertension. Conclusion: Scleroderma Renal Crisis is characterized by acute kidney injury and maglinant hypertension; it has poor outcome and high mortality rate. Risk factors have been shown in this study include anemia, pulmonary hypertension, heart failure, age over 58 years old, duration of systemic scleroderma less than 4 years, methyl-prednisolon dose over 16 mg per day, thrombocytopenia and hypertension. Thrombocytopenia is one of the risk factors of poor outcome (p = 0,021).