Progressive blindness as the first presentation of advanced chronicrenal failure !

Clinical scenario:  

               A 48-year-old male presented with history of progressive visual loss  in both eyes of two weeks duration .He also complained of generalized fatigue of same duration .He denied any history of  trauma or offending drug intake . The patient was non diabetic , normotensive and denied any other systemic illness .

Examination:

       The patient was conscious and oriented. He had normal vitals . Icterus, lymphadenopathy and edema were absent. The  systemic examination were normal. There was no neurodefecit

Eye examination :

Patients visual acuity was reduced to finger counting in both eyes .

The external examination of eye was normal  and all ocular muscles were normal .

Fundus examination was normal too .

Evaluation: 

         He had hemoglobin of 10.2 gm/dl , white cell count and erythrocyte sedimentation rate were normal as well. Tests of liver function were normal .Renal function tests revealed Urea of  215 mg/dl and creatinine levels were 15 mg /dl    His chest X-ray was normal.

 The ultrasound examination showed  reduced size of both kidneys and no features of obstructive uropathy was seen .The cortico medullary differentiation was lost on both sides  .The over all features were suggestive of chronic kidney disease The liver, gallbladder and other organs were normal.

Fig.1  The USG shows shrunken kidney  Yellow circle shows what  the size of kidney should have been  

     

COURSE :  

Patient was given Hemo dialysis and he had progressive improvement of his vision over a period of three weeks . 

Teaching message :

Blindness can be first presentation of chronic kidney disease and is reversible with dialysis  

            

For further Reading click the Link: Chronic Kidney Disease 

This case was Contributed by :

Dr Ahmad  Al Zaidi  & Dr Irshad Sirwal 

Dept of Nephrology 

King Abdul Aziz Specialist Hospital

Taif Saudi Arabia