Rheumatologic disorders

Consensus Met on Scleroderma Renal Crisis Classification Criteria

A panel of 99 experts from 16 countries, including the United States, has agreed on a core set of items to use in the classification of scleroderma renal crisis (SRC).


The multidisciplinary panel participated in a 3‐round Delphi exercise, which was developed using a survey based on items identified by a scoping review:


Round 1: The participants identified omissions and clarified ambiguities regarding the survey’s items.

Round 2: Using Likert‐type scales ranging from 1-9 (1 = very invalid/unfeasible, 5 = uncertain, 9 = very valid/feasible), the experts rated the validity and feasibility of the items.

Round 3: After reviewing the result and comments of Round 2, the participants provided final ratings. Items rated as highly valid and feasible (both median scores ≥7) in Round 3 were selected as the provisional core set of items.


The experts reached a consensus on 13 of the 31 items in the survey, including hypertension, renal insufficiency, proteinuria, and hemolysis.


To further reduce the core set of items, 11 of the experts participated in a nominal group technique discussion. During that, consensus was reached in the 5 areas of blood pressure, acute kidney injury, microangiopathic hemolytic anemia, target organ dysfunction, and renal histopathology.


“This core set will be used in future data‐driven phases of this project to develop classification criteria for SRC,” the researchers concluded.


—Colleen Murphy



Emily‐Ann Butler, Murray Baron, Agnes B. Fogo, et al. Generation of a core set of items to develop classification criteria for Scleroderma renal crisis using consensus methodology [published online January 7, 2019]. Arthritis Rheumatol.