Can ACE Inhibitors Help Prevent Renal Crisis in Scleroderma?

A Chinese meta-analysis of studies on the treatment of scleroderma has investigated whether ACE inhibitors can be used to prevent renal crisis.

Renal crisis in scleroderma

Scleroderma or systemic sclerosis is a rare autoimmune disease that affects the connective tissue. Those affected may suffer from Raynaud's syndrome, hardening of the skin and a condition called mask face, among other symptoms. In more advanced cases, patients may also suffer from hardening of the internal organs, including the lungs. If the kidneys are affected, a renal crisis (SRC) may develop. About 5% of scleroderma patients show clinical signs of SRC. The leading symptoms are high blood pressure and acute renal failure. ACE inhibitors are used as standard therapy for the crisis.

ACE inhibitors under scrutiny for the prevention of renal crisis

In recent years, ACE inhibitors have been used in patients with systemic sclerosis even before they developed a renal crisis. Chinese researchers conducted a meta-analysis of the existing studies to gain clarity on whether this practice actually has benefits for people with the disease.

They included nine studies in the analysis and the results are unequivocal. If scleroderma patients were already treated with ACE inhibitors before a renal crisis, it did not prevent the exacerbation but rather promoted its development. In addition, the prognosis was worse under therapy with the active substance. Both results were statistically significant.

What does this mean in practice?

The use of ACE inhibitors prior to the development of a renal crisis should be avoided in scleroderma patients. Taking a drug from this class of agents does not improve the outcome, but is associated with an increased incidence of renal crisis and a poorer prognosis.

Xiong A, Cao Y, Xiang Q, Song Z, Zhang Y, Zhou S, Qiang Y, Chen H, Hu Z, Cui H, Luo J, Wang Y, Yang Y, Yang M, Shuai S. Angiotensin-converting enzyme inhibitors prior to scleroderma renal crisis in systemic sclerosis: A systematic review and meta-analysis. J Clin Pharm Ther. 2022 Mar 1. Epub ahead of print. PMID: 35233779.