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. 2022 Jul 15;86(6):e2021-0314.
doi: 10.5935/0004-2749.2021-0314. Online ahead of print.

Severe bilateral visual loss as the first sign of IgA nephropathy

Leonardo Provetti Cunha  1   2   3 , Raphael Lucas Sampaio Defina  1 , Rony Carlos Preti  2 , Luciana Virgínia Ferreira Costa-Cunha  3 , Leandro Cabral Zacharias  2 , Kenzo Hokazono  4 , Mário Luiz Ribeiro Monteiro  5
Affiliations

Severe bilateral visual loss as the first sign of IgA nephropathy

Leonardo Provetti Cunha et al. Arq Bras Oftalmol. .

Abstract
in English, Portuguese

We describe a case of a 33-years-old woman who presents with severe acute bilateral visual loss secondary to massive exudative hypertensive maculopathy as the first sign of immunoglobulin A nephropathy. The patient's ophthalmic examination showed bilateral cotton-wool spots, flame-shaped retinal hemorrhages, diffuse narrow arterioles, optic disk edema, and exudative maculopathy. Systemic workup demonstrated a systolic and diastolic blood pressure of 240 mmHg and 160 mmHg, respectively, proteinuria, and hematuria, suggesting kidney disease as the causative condition. A kidney biopsy confirmed immunoglobulin A nephropathy. She was treated with systemic corticosteroids, antihypertensive drugs, and a single bilateral intravitreal injection of aflibercept. There was a prompt resolution of macular edema and vision improvement. Our case draws attention to the fact that severe bilateral visual loss can be the first sign of severe hypertension. Secondary causes, such as immunoglobulin A nephropathy, should be ruled out.

Nosso objetivo é descrever uma paciente de 33 anos de idade, com perda visual bilateral grave por maculopatia hipertensiva exsudativa como o primeiro sinal da nefropatia por imunoglobulina A. A fundoscopia revelou a presença de manchas algodonosas, hemorragias em chama-de-vela, estreitamento arteriolar difuso, edema de disco óptico e maculopatia exsudativa bilateral. A pressão arterial sistólica foi de 240mmHg e a diastólica de 160 mmHg associado a proteinúria e hematúria, sugerindo a presença de doença renal. A biópsia renal confirmou a nefropatia por imunoglobulina A. A paciente foi tratada como corticoide sistêmico, drogas anti-hipertensivas e uma única dose intravítrea de Aflibercept em ambos os olhos. Houve rápida melhora do edema macular e da acuidade visual. Nosso caso chama a atenção para o fato de que a perda visual bilateral grave pode ser a primeira apresentação de uma doença hipertensiva sistêmica. Causas secundárias como a nefropatia por imunoglobulina A devem ser afastadas.

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Conflict of interest statement

Disclosure of potential conflicts of interest: None of the authors have any potential conflicts of interest to disclose.

Figures

Figure 1
Figure 1
(A) A fundus retinography of both eyes shows bilateral cotton-wool spots, flame-shaped retinal hemorrhages, diffuse narrowed arterioles, mild optic disk edema, and exudative maculopathy. A blue horizontal line shows an optical coherence tomography (OCT) scanned area. (B) Swept-source OCT B-scans show bilateral macular edema with intraretinal cysts and a massive subretinal fluid in both eyes.
Figure 2
Figure 2
(A) Fundus retinography and swept-source OCT B-scans three weeks after the procedure show remarkable improvement in both eyes. (B) Note the additional absorption of subretinal fluid in the OD after 10 weeks.
See this image and copyright information in PMC

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