Revealing the Intersection: Scleroderma Renal Crisis Complicating Membranous Nephropathy

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.