A case of scleroderma renal crisis involving difficulties with selecting a dialysis method and making an arteriovenous fistula for hemodialysis

Abstract

We report a case of renal failure caused by scleroderma renal crisis (SRC), which required the initiation of hemodialysis. The patient was a 44-year-old female, who developed SRC approximately 2 years after being diagnosed with systemic sclerosis (SSc). She was prescribed angiotensin-converting enzyme inhibitors, but her renal function did not improve. As a renal transplant was not an option, it was recognized that she would eventually require hemodialysis or peritoneal dialysis. It was difficult to decide on the ideal type of dialysis. For example, the patient’s comorbidities (SSc and vascular lesions) presented challenges with regard to maintaining vascular access for hemodialysis, and the skin tightening caused by her SSc hindered fine movement, which is a requisite for maintaining a peritoneal dialysis catheter. Ultimately, the patient opted for hemodialysis, but there were difficulties establishing a functional arteriovenous fistula. SSc is a connective tissue disease, involving multiple organs, and it is characterized by skin dysfunction and vascular injuries; therefore, little is known about the stability of peritoneal clearance in patients with SSc. For these reasons, the management of SSc patients with renal failure requires further study, and there is a need to develop an appropriate maintenance dialysis method for such patients.