Sudden Renal Failure in a Scleroderma Patient: A Clinical Dilemma.

Scleroderma is a connective tissue disease which may present with renal crisis. But sometimes, acute renal failure in scleroderma may be due to a second pathology. We here present a case of a 35 year old woman with systemic sclerosis, who presented with acute renal failure. She was started treatment as a case of scleroderma renal crisis. But her condition continued to deteriorate and she also developed some cutaneous vasculitic lesions. Her urine also had active sediments. Finally, serology and kidney biopsy established the renal lesion as stage IV lupus nephritis. She responded to immunosuppressive regimen for lupus with rapid improvement of kidney function. Such overlap of scleroderma with lupus is very rarely reported.