WCN25-4030 EFFECT OF CONTINUOUS POSITIVE AIRWAY PRESSURE ON RENAL FUNCTION AND RELATED METRICS IN DIABETIC KIDNEY DISEASE PATIENTS WITH OBSTRUCTIVE SLEEP APNEA: A RANDOMIZED CLINICAL TRIAL

Alternate day Plasma exchange (PE) was started.Considering 3+ proteinuria, evidence of myocarditis and worsening on ACE-inhibitor, a possibility of overlap AAV or SLE was considered.Appropriate serological workup was sent and renal biopsy was planned.With 5 sessions of PE she had improvement in her symptoms, platelet count, MAHA and renal function (she became dialysis independent).Renal biopsy showed arteriolar thrombotic microangiopathic hemolytic anemia (TMA) suggestive of scleroderma renal crisis (SRC).Follow-up Echo showed resolution of cardiac dysfunction without institution of immunosuppression.Conclusions: SRC is characterized by development of malignant hypertension, acute kidney injury and MAHA, it can cause end organ damage of other critical organs like heart, lung and gastrointestinal tracts.Angiotensin convertase enzyme inhibitors (ACEi) are the 1st line agent despite the unavailability of randomized control trials.However, for patient not responding to ACEi, there is no clear evidence to guide further management.Various authors have suggested using PE in cases of ACEi non-responsiveness or TMA dominant picture.However, these suggestions are mostly based on limited case reports.One retrospective study comprising 20 patients with SRC used PE in combination with ACEi and showed better survival at 1-year followup compared to ACEi alone.However, not all subsets of SRC patients are likely to benefit from addition of PE.Additional studies are needed to identify the subset of SRC patients most likely to benefit from PE, and the precise role of combination ACEi and PE.I have no potential conflict of interest to disclose.I did not use generative AI and AI-assisted technologies in the writing process.