Bilateral retinal detachment – when the kidney meets the eye

Abstract

Exudative retinal detachment occurs when fluid accumulates between the neurosensory retina and the retinal pigment epithelium. Ocular diseases or multisystem conditions such as nephrotic syndrome may lead to exudative retinal detachment. This report describes a case of nephrotic syndrome secondary to minimal change disease, anasarca and bilateral serous macular detachment in an adult patient. A 75-year-old male patient presented to the emergency department with generalized edema, asthenia, and visual impairment. Medical history included a recent diagnosis of nephrotic syndrome secondary to minimal change disease, which had been controlled with corticosteroid therapy. At presentation, best corrected visual acuity was 20/100. Slit-lamp examination revealed xanthelasmas and mild bilateral eyelid edema and chemosis. Dilated fundus examination confirmed bilateral macular detachment. The patient did not respond to diuretic therapy. Ttherefore, hemodialysis was started. Two months later, visual acuity improved to 20/25 and near normal restoration of retinal anatomy was achieved, with concurrent remission of proteinuria. Exudative retinal detachment is a multifactorial condition. However, in diseases associated with severe hypoalbuminemia, such as nephrotic syndrome, low oncotic pressure in choroidal vessels and high interstitial pressure in the choroid may explain retinal detachment. Patients with chronic kidney disease carry a high risk of ophthalmic disease development. Several mechanisms that affect ocular vessels, the retina and the choroid are thought to be involved. A multidisciplinary approach is crucial to resolve the ophthalmic condition and improve overall health.

A Case of Nephrotic Syndrome with Bilateral Serous Retinal Detachment and Shallow Anterior Chamber Associated with Ciliary Body Edema

“…The improvement in the ocular findings that was associated with the improvement of interstitial fluid due to dialysis treatment additionally suggests that there was a strong of a leaky vessel mechanism in the eye. Henriques et al [13] similarly reported finding a case of nephrotic syndrome that was diagnosed a month earlier and then treated with steroids, with the patient subsequently unresponsive to the treatment, which led to the same type of ocular symptoms. Moreover, as was found in our present case, this previous patient also had extensive SRD with intraretinal edema in about 4 papillae in the posterior pole.…”

“…Henriques et al [ 13 ] similarly reported finding a case of nephrotic syndrome that was diagnosed a month earlier and then treated with steroids, with the patient subsequently unresponsive to the treatment, which led to the same type of ocular symptoms. Moreover, as was found in our present case, this previous patient also had extensive SRD with intraretinal edema in about 4 papillae in the posterior pole.…”

Acute Vision Loss and Conjunctival Hemorrhage as Telltale Symptoms of PIMS-TS

“…Ocular diseases or multisystem conditions may lead to exudative retinal detachment. 15 Gass has suggested that the uremic state in patients with renal failure can lead to serous retinal detachment. 16 Acute kidney injury (AKI) is a common finding in PIMS-TS.…”