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Sadeghi R, Pashapouryeganeh A, Karimi M, Khalili Pour E, Mirghorbani M, Riazi-Esfahani H. Bilateral central serous retinal detachment in a patient with nephrotic syndrome: a case report. J Med Case Rep 2023; 17:490. [PMID: 37996887 PMCID: PMC10668382 DOI: 10.1186/s13256-023-04236-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 10/31/2023] [Indexed: 11/25/2023] Open
Abstract
BACKGROUND The aim of this report is to highlight the importance of considering nephrotic syndrome as a potential underlying cause of bilateral central serous retinal detachment in a patient with systemic lupus erythematosus and to underscore the significance of a comprehensive systemic workup in these patients. CASE PRESENTATION A 19-year-old Iranian female patient with history of systemic lupus erythematosus presented with progressive vision loss and bilateral macular elevation. Ophthalmic examination revealed periorbital edema, chemosis, and subretinal fluid at the macula of both eyes. Optical coherence tomography confirmed the existence of subretinal fluid and serous detachment located at the macula of both eyes. On fluorescein angiography, there were no signs of subretinal leakage such as smoke stack sign or expansile dot in late phases. Laboratory tests detected hypoalbuminemia and significant proteinuria, leading to the diagnosis of nephrotic syndrome. Treatment with prednisolone and albumin infusion resulted in improved visual acuity and resolution of subretinal fluid. CONCLUSION Nephrotic syndrome can be a rare underlying cause of bilateral central serous retinal detachment, and its association with systemic lupus erythematosus should be considered. Hypoalbuminemia in nephrotic syndrome alters fluid dynamics in the retina, contributing to bilateral central serous retinal detachment. Early recognition and management of nephrotic syndrome are essential for vision recovery and preventing long-term complications.
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Affiliation(s)
- Reza Sadeghi
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Farabi Hospital, Qazvin Square, Tehran, 1336616351, Iran
| | - Amirreza Pashapouryeganeh
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Farabi Hospital, Qazvin Square, Tehran, 1336616351, Iran
| | - Morteza Karimi
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Farabi Hospital, Qazvin Square, Tehran, 1336616351, Iran
| | - Elias Khalili Pour
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Farabi Hospital, Qazvin Square, Tehran, 1336616351, Iran
| | - Masoud Mirghorbani
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Farabi Hospital, Qazvin Square, Tehran, 1336616351, Iran
| | - Hamid Riazi-Esfahani
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Farabi Hospital, Qazvin Square, Tehran, 1336616351, Iran.
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Mun-Wei L, Aiman-Mardhiyyah MY, Hayati AA, Ikram IM, Tai ELM, Shatriah I. Evaluation of Visual Acuity, Macular Thickness, and Level of Proteinuria in Children with Nephrotic Syndrome. Korean J Ophthalmol 2023; 37:42-48. [PMID: 36549302 PMCID: PMC9935067 DOI: 10.3341/kjo.2021.0131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 11/03/2022] [Indexed: 12/24/2022] Open
Abstract
PURPOSE Macular edema, serous retinal detachment, and retinal pigment epithelial detachment have been reported in patients with nephrotic syndrome. However, there is limited data about macular thickness in children with nephrotic syndrome. The aim of this study was to compare the mean macular thickness in children with nephrotic syndrome and in a control group and to correlate it with visual acuity and level of proteinuria. METHODS The comparative cross-sectional study included 66 children aged 6 to 17 years with nephrotic syndrome and healthy control seen in two tertiary centers in Malaysia. We recorded demographic data, as well as visual acuity, level of proteinuria, and the mean macular thicknesses in both groups. The mean macular thickness was measured using Stratus optical coherence tomography according to nine areas of the Early Treatment Diabetic Retinopathy Study map. RESULTS The mean foveal thickness was 238.15 ± 22.98 µm for children with nephrotic syndrome and 237.01 ± 22.60 µm for the control group. There was no significant difference in the mean macular thickness between the groups (p = 0.843). A significant correlation with visual acuity was observed in the superior outer macula (r = -0.41, p = 0.019), the nasal outer macula (r = -0.41, p = 0.019), and the inferior outer macula (r = -0.40, p = 0.021). There was no significant correlation between the mean macular thickness and level of proteinuria (p = 0.338), although those with higher levels of proteinuria demonstrated a trend towards increased macular thickness. CONCLUSIONS The mean macular thickness in children with nephrotic syndrome was similar to that of healthy children. A significant correlation between the mean thickness of the outer macular layer and the presenting visual acuity was observed. There was no correlation between the mean macular thickness and the level of proteinuria.
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Affiliation(s)
- Lam Mun-Wei
- Department of Ophthalmology, Sultanah Aminah Hospital, Johor,
Malaysia
- Hospital Universiti Sains Malaysia, Kelantan,
Malaysia
- Department of Ophthalmology and Visual Science, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian,
Malaysia
| | - Mohd Yazid Aiman-Mardhiyyah
- Hospital Universiti Sains Malaysia, Kelantan,
Malaysia
- Department of Ophthalmology and Visual Science, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian,
Malaysia
| | - Abdul Aziz Hayati
- Department of Ophthalmology, Sultanah Aminah Hospital, Johor,
Malaysia
| | - Ilias Mohamad Ikram
- Department of Pediatrics, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian,
Malaysia
| | - Evelyn Li Min Tai
- Hospital Universiti Sains Malaysia, Kelantan,
Malaysia
- Department of Ophthalmology and Visual Science, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian,
Malaysia
| | - Ismail Shatriah
- Hospital Universiti Sains Malaysia, Kelantan,
Malaysia
- Department of Ophthalmology and Visual Science, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian,
Malaysia
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Zhang X, Hao X, Wang L, Xie L. Association of Abnormal Renal Profiles with Subretinal Fluid in Diabetic Macular Edema. J Ophthalmol 2022; 2022:5581679. [PMID: 36561389 DOI: 10.1155/2022/5581679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 11/20/2022] [Accepted: 11/21/2022] [Indexed: 12/15/2022] Open
Abstract
Purpose To investigate the risk factors for subretinal fluid (SRF) in diabetic macular edema (DME). Methods We reviewed the records of 66 patients with DME. Systemic parameters, including hypertension, glycosylated hemoglobin, serum fasting glucose, total cholesterol, triglycerides, and diabetic kidney disease, were evaluated. Renal parameters for diabetic kidney disease included serum albumin, serum creatinine, albuminuria, and estimated glomerular filtration rate. Ocular factors included visual acuity and diabetic retinopathy, and the following parameters are evaluated through optical coherence tomography examination: disorganization of the retinal inner layers, loss of ellipsoid zone, central subretinal fluid thickness, central macular thickness, and presence of SRF. Results Higher albuminuria (odds ratio, 3.431; 95% confidence interval, 1.039-11.334; P=0.043) was associated with the presence of SRF in patients with DME. Lower serum albumin levels (beta = -14.028, se = 6.646, P=0.044) were associated with increased SRF thickness. Conclusions Poor kidney function was associated with the presence of SRF in DME. Screening for SRF in DME in patients with higher albuminuria and lower serum albumin levels should be routinely performed.
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Lee LC, Wu TJ, Huang KH, Chen YH, Chen JT, Chung CH, Chien WC, Chen CL. Increased risk for central serous chorioretinopathy in nephrotic syndrome patients: A population-based cohort study. J Chin Med Assoc 2021; 84:1060-1069. [PMID: 34320516 DOI: 10.1097/jcma.0000000000000591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Nephrotic syndrome (NS) is characterized by various etiologies that damage the glomerulus. Central serous chorioretinopathy (CSCR) is a retinal disease characterized by neurosensory detachment of the retina. Several case reports have described the relationship between both. Therefore, we try to analyze the epidemiological associations between NS and CSCR using the National Health Insurance Research Database in Taiwan. METHODS Data spanning 14 years were extracted from the National Health Insurance Research Database and sub-grouped. The variables were analyzed using Pearson's chi-squared test and Fisher's exact test. The risk factors for disease development with or without comorbidities were examined using an adjusted hazard ratio (aHR). Kaplan-Meier analysis was performed to evaluate the cumulative incidence of CSCR with or without NS. RESULTS A total of 14 794 patients with NS and 14 794 matched controls without NS were enrolled in this cohort study. The incidence rate of CSCR was higher in the study cohort than in the control cohort (aHR = 3.349, p < 0.001). The overall incidence of CSCR was 44.51 per 100 000 person-years in the study cohort and 33.39 per 100 000 person-years in the control cohort. In both groups, CSCR occurred more frequently in males than in females. Patients aged 40-49, 50-59, and ≥60 years in the study cohort had a significantly higher risk of developing CSCR than those in the control cohort (aHR = 3.445, 5.421, and 4.957, all p < 0.001). NS patient with a 4-week history of steroid usage has a higher risk of developing CSCR (aHR = 2.010, p < 0.001). CONCLUSION Our data showed that patients with NS have an increased risk of developing subsequent CSCR. Physician should routinely refer their NS patients to ophthalmologist for ophthalmic evaluation. This is the first nationwide epidemiological study reporting the association between these two diseases. Further studies are needed to clarify this relationship.
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Affiliation(s)
- Lung-Chi Lee
- Department of Ophthalmology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Tai-Jung Wu
- Department of Nephrology, Department of Internal Medicine, Fu Jen Catholic University Hospital, Taipei, Taiwan, ROC
| | - Ke-Hao Huang
- Department of Ophthalmology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
- Department of Ophthalmology, Songshan Branch of Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Yi-Hao Chen
- Department of Ophthalmology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Jiann-Torng Chen
- Department of Ophthalmology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Chi-Hsiang Chung
- Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
- School of Public Health, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Wu-Chien Chien
- Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
- School of Public Health, National Defense Medical Center, Taipei, Taiwan, ROC
- Taiwanese Injury Prevention and Safety Promotion Association, Taipei, Taiwan, ROC
- Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Ching-Long Chen
- Department of Ophthalmology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
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Yeung SC, Ma PE. Exudative retinal detachment secondary to hypertensive crisis related to membranous nephropathy. Can J Ophthalmol 2020; 56:e28-e30. [PMID: 32721382 DOI: 10.1016/j.jcjo.2020.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 06/19/2020] [Accepted: 06/26/2020] [Indexed: 11/19/2022]
Affiliation(s)
| | - Patrick E Ma
- University of British Columbia, Vancouver, B.C..
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Zhang W, Zhang Y, Kang L, Gu X, Wu H, Yang L. Retinal and choroidal thickness in paediatric patients with hypoalbuminaemia caused by nephrotic syndrome. BMC Ophthalmol 2019; 19:44. [PMID: 30727992 PMCID: PMC6364472 DOI: 10.1186/s12886-019-1050-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 01/29/2019] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND A study was conducted to evaluate the choroidal thickness (CT) and retinal thickness (RT) in paediatric patients with hypoalbuminaemia caused by nephrotic syndrome (NS). We also studied the correlation between the subfoveal choroidal thickness (SFCT) and serum protein concentration. METHODS This was a cross-sectional study. Fifty-one paediatric patients with hypoalbuminaemia caused by NS and 41 normal subjects were included in the study. Enhanced depth imaging optical coherence tomography (EDI-OCT) was performed to measure the RT and CT. The RT and CT were measured manually at intervals of 0.5 mm along a horizontal line through the macular fovea between 2.5 mm nasal and 2.5 mm temporal to the fovea. Clinical data including measurements of serum proteins were obtained. RESULTS The mean RTs at the T2.5, T2, N1.5, N2, and N2.5 locations and the average macular horizontal RT were slightly greater in the NS group than those in the control group. The mean CTs at all locations were significantly greater in the NS group than those in the control group; the difference was most significant at the fovea (373.8 ± 74.9 μm vs. 280.2 ± 57.1; p < 0.001). The SFCT in patients with NS was correlated with age (r = - 0.307, p = 0.003), body height (r = - 0.320, p = 0.022), body weight (r = - 0.343, p = 0.014), axial length (AL, r = - 0.237, p = 0.023), total protein (TP, r = - 0.302, p = 0.031), albumin (ALB, r = - 0.285, p = 0.042), prealbumin (PA, r = - 0.303, p = 0.033) and 24-h urine volume (UV, r = - 0.298, p = 0.034). Multiple linear regression analysis showed that the TP concentration and body weight had the highest correlation with the SFCT (R2 = 0.220, p < 0.05). CONCLUSIONS The macular RT is slightly increased and the macular CT is significantly increased in paediatric patients with hypoalbuminaemia caused by NS, indicating fluid accumulation in the retina and choroid. There is a negative correlation between the SFCT and serum TP concentration. Thus, the serum TP concentration is an important indicator of CT in patients with hypoalbuminaemia.
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Affiliation(s)
- Wenbo Zhang
- Department of Ophthalmology, Peking University Frist Hospital, No. 8 Xishiku Street, Xicheng District, Beijing, 100034 China
| | - Yadi Zhang
- Department of Ophthalmology, Peking University Frist Hospital, No. 8 Xishiku Street, Xicheng District, Beijing, 100034 China
| | - Lei Kang
- Department of Ophthalmology, Peking University Frist Hospital, No. 8 Xishiku Street, Xicheng District, Beijing, 100034 China
| | - Xiaopeng Gu
- Department of Ophthalmology, Peking University Frist Hospital, No. 8 Xishiku Street, Xicheng District, Beijing, 100034 China
| | - Hailong Wu
- Department of Ophthalmology, Peking University Frist Hospital, No. 8 Xishiku Street, Xicheng District, Beijing, 100034 China
| | - Liu Yang
- Department of Ophthalmology, Peking University Frist Hospital, No. 8 Xishiku Street, Xicheng District, Beijing, 100034 China
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Tsai MJ, Hsieh YT, Shen EP, Peng YJ. Systemic Associations with Residual Subretinal Fluid after Ranibizumab in Diabetic Macular Edema. J Ophthalmol 2017; 2017:4834201. [PMID: 28819567 DOI: 10.1155/2017/4834201] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Revised: 06/09/2017] [Accepted: 07/09/2017] [Indexed: 12/31/2022] Open
Abstract
PURPOSE To investigate the impact of systemic diseases on the occurrence of subretinal fluid (SRF) in diabetic macular edema (DME) and prognostic factors for residual SRF following three consecutive monthly intravitreal ranibizumab. METHODS Ninety-seven eyes from 68 patients with DME who completed 3 consecutive monthly injections of ranibizumab were enrolled. Systemic parameters mainly included chronic kidney disease (CKD), hypertension, HbA1c, and insulin dependence. Renal parameters for CKD were serum creatinine, estimated glomerular filtration rate (eGFR), and serum albumin. Ocular factors were baseline central macular thickness (CMT), severity of diabetic retinopathy (DR), and status of panretinal photocoagulation (PRP). RESULTS Chronic kidney disease had significant correlation with baseline SRF (R = 0.397, p < 0.001 after partial correlation with adjustment for age and DR severity). As for CKD, lower serum albumin, but not eGFR or serum creatinine, was associated with baseline presence of SRF (p = 0.026, p = 0.08 and p = 0.53, resp., after adjustment for age and DR severity). Overall, lower eGFR and lower HbA1c values, contrary to popular belief, predicted the presence of residual SRF following intravitreal injections (p = 0.016 and p < 0.001, resp.). CONCLUSIONS Tight sugar control and poorer baseline kidney function may slow the resorption of SRF after anti-VEGF injections in patients with DME in the short term.
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Affiliation(s)
- B Bodaghi
- Department of Ophthalmology, DHU ViewMaintain , UPMC, APHP, Pitié-Salpêtrière Hospital , Paris , France
| | - N Massamba
- Department of Ophthalmology, DHU ViewMaintain , UPMC, APHP, Pitié-Salpêtrière Hospital , Paris , France
| | - H Izzedine
- Department of Nephrology , UPMC, APHP, Pitié-Salpêtrière Hospital , Paris , France
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Abstract
We herein present a case of bilateral serous retinal detachment (SRD) as a presenting sign of nephrotic syndrome (NS). A 48-year-old man complained of decreased vision related to bilateral SRD. Laboratory tests revealed NS (serum albumin, 17 g/L: proteinuria, 15.40 g over 24 hours). Following treatment for edema with a diuretic, the bilateral SRD resolved completely, with a full recovery of the patient's vision. A kidney biopsy disclosed glomerular and vascular amyloid deposits; the amyloid stained strongly with anti-λ antiserum. Therefore, a diagnosis of AL amyloidosis was made. The sudden appearance of SRD should raise suspicion of a diagnosis of NS. Prompt recognition of this symptom is important for early treatment and restoration of the visual function.
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Affiliation(s)
- Hassan Izzedine
- Department of Nephrology, Pitie Salpetriere Hospital, France
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