can COVID ppt Scleroderma renal crisis??

Scleroderma renal crisis, scleroderma, ILD, Hypertension, Hypothyroidism with COVID pneumonitis. Chief Complaints Suspected Scleroderma renal crisis in a pt of Scleroderma with COVID Ag positive, ILD, hypothyroidism, Covid pneumonitis. A 40 yr old female has come with complaints of multiple episodes of hemoptysis since 5 days. Pt is having polyarthralgia for past 1 yr and taking HCQ and steroids. She is a known HTN and taking febuxostat for hyperuricemia. Pt has neg RF and anti ccp, but positive ANA. On examination pt has b/l pedal edema, microstomia, scleroderma and skin tightening with pigmentation over hand and face I, e sun exposed area. No other features. No crepts on auscultation. Sent sample for routine Ix, sputum for AFB and C/S. CXR and serum anti Ds DNA, anti SCL 70 and anti centromere . Suspecting secondary systemic sclerosis due to SLE.also planned for CT thorax. Pt is covid rat neg. I advised CT thorax, anti Scl 70,anti ds DNA and anti centromere, waiting for report. She also complained for repeated ulcers in fingers.. Which is stress ulcer. No features of raynouds phenomenon.. change of color of fingers is absent ... Rt pcr for covid was neg on 21 nov. The pt got admited today with SOB, SPO2 of 73%, HTN crisis (BP-210/110), B/L pedal edema. She was covid rat neg and RT pcr neg as on 21 Nov. Her rft is deranged, raised TSH, TLC increased, ESR raised, CRP neg, proteinuria and RBC in urine. Most probably she is in scleroderma renal crisis Pt is maintaining saturation on O2. CT thorax showing ground glass opacity, features of ILD with suspected infective pathology Today We did repeat Covid rat which came to be positive. We are giving ramipril and amlodipine bcoz captopril, short and fast acting acei is unavailable. Pt may require dialysis. Also steroid and lasix can't be given bcoz that will aggravate her Renal crisis. Pt has come positive for covid.. Which ppt scleroderma renal crisis??

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Very interesting case Crux of the matter is - is there Scleroderma renal crisis? Scleroderma renal crisis is caused by vasospasm of renal artery resulting in renal ischaemia, it causes oliguric renal failure, and there is severe hypertension Therefore, of urine output is normal, or if oliguria is absent or it reduces the possibility of scleroderma renal crisis High blood pressure, raised creatinine is commonly seen in Covid 19, therefore there is a possibility that it can be related to Covid 19 Adv Ace inhibitors for high blood pressure Treatment of Covid 19 with - ivermectin, Doxycycline, Azithromycin, Low molecular weight heparin and Glargine insulin Glargine insulin has very important role in treatment of Covid 19 Low dose Glargine insulin is effective in treatment of nondiabetic patient with Covid 19 Please read my article on same https://dx.doi.org/10.18535/jmscr/v8i7.103

Blood pressure control with angiotensin-converting enzyme (ACE) inhibitors with gradual reduction of malignant hypertension is the cornerstone of treatment. Other agents such as calcium channel blocking agents may be added. Renal dialysis may even be required.

Hydration, Intake output monitoring Reduction of BP, treatment of covid pneumonia including LMWH oxygen support.

Post covid renal crisis with scleroderma is emergency condition were we need to monitor vitals .patient may go in to permanent renal problem .complete evaluation is required under expert

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