# Revealing the Intersection: Scleroderma Renal Crisis Complicating Membranous Nephropathy

## TL;DR

This case study describes a patient with systemic sclerosis and membranous nephropathy who developed severe kidney complications requiring dialysis.

## Contribution

The novelty lies in highlighting the rare and complex interplay between scleroderma renal crisis and membranous nephropathy in a single patient.

## Key findings

- The patient exhibited dual renal pathology: membranous nephropathy and scleroderma renal crisis.
- Despite treatment, the patient developed flash pulmonary oedema requiring haemodialysis.
- The case emphasizes the importance of early recognition of scleroderma renal crisis in patients with overlapping renal conditions.

## Abstract

An 82-year-old woman with systemic sclerosis (anti-topoisomerase I (anti-Scl-70) positive) and a history of membranous nephropathy presented with a prolonged illness marked by worsening oedema, reduced urine output, and severe hypertension. Laboratory investigations revealed nephrotic-range proteinuria, acute kidney injury (AKI), and a marked decline in renal function. Initial treatment with diuretics and antihypertensive therapy yielded limited improvement. Renal biopsy demonstrated dual pathology: primary membranous nephropathy and acute vascular changes indicative of scleroderma renal crisis (SRC). Despite targeted therapy, the patient experienced flash pulmonary oedema, necessitating haemodialysis. This case highlights the complexities of diagnosing and managing overlapping renal pathologies in systemic sclerosis, underscoring the critical importance of early recognition and intervention in SRC.