ACE Inhibitor-induced Acute Renal Failure in a Patient with Progressive Systemic Sclerosis: Ischemic Nephropathy Mimicking PSS Renal Crisis

A 79-year-old woman with progressive systemic sclerosis (PSS) presented with acute pulmonary edema, hypertension and renal failure. Administration of angiotensin-converting enzyme (ACE) inhibitor under suspicion of PSS renal crisis resulted in worsening of the renal function, which necessitated hemodialysis. Magnetic resonance arteriogram (MRA) demonstrated stenosis of the right renal artery, and ischemic nephropathy was diagnosed. Renal function improved after the discontinuation of ACE inhibitor. ACE inhibitor/angiotensin II receptor blocker (ARB), which is recommended for PSS renal crisis, should be avoided in ischemic nephropathy. In elderly PSS patients, careful exclusion of ischemic nephropathy is warranted before the administration of ACE inhibitor/ARB.