This is a real-world medical entrance exam question, please give the true answer based on the question and selection. Topic name: Scleroderma, Subject name: Medicine
Indication of poor prognosis of systemic sclerosis is: 
Select and explain. 
A. Calcinosis cutis, B. Renal involvement, C. Alopecia, D. Telangiectasia
B: Renal involvement
Answer: B: Renal involvement 
Explanation: * Patients with diffuse, rapid skin involvement have the highest risk of developing scleroderma renal crisis. Renal crisis occurs in about 10% of all patients with systemic sclerosis and is indicative of bad prognosis. * Renal crisis presents as accelerated hypeension, oliguria, headache, dyspnea, edema, and rapidly rising serum creatinine levels. * Renal crisis is observed within 4 years of diagnosis in about 75% of patients but may develop as late as 20 years after diagnosis. * Avoid high doses of coicosteroids since this is a significant risk factor for renal crisis.