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Oo HH, Choy MYD, Arora A, Yeo SC, Ramachandran R, Gupta V, McCluskey P, Agrawal R. Ocular manifestations in IgA nephropathy. Surv Ophthalmol 2023; 68:290-307. [PMID: 36191648 DOI: 10.1016/j.survophthal.2022.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 09/20/2022] [Accepted: 09/26/2022] [Indexed: 11/28/2022]
Abstract
Immunoglobulin A nephropathy (IgAN) is a rare but important systemic disease with or without ocular manifestations. We describe 4 cases of IgAN presenting with scleritis and review the various ocular manifestations in patients with IgAN. We found 55 cases with ocular manifestations in patients with prior or newly-diagnosed IgAN described in 38 publications. The most common ocular manifestations of IgAN were episcleritis (23.6%), scleritis (16.4%), hypertensive retinopathy or retinal vasculopathy (20.0%), and uveitis (14.5%). The median age at presentation was 36.5 years, with 54.5% female patients. 61.8% had history of IgAN prior to ocular involvement, while 29.1% had ocular presentations as the first manifestation of IgAN. The majority received systemic corticosteroids and/or immunosuppressants. Additionally, we report 4 women with anterior scleritis and previous diagnosis of IgAN. All 4 were treated with topical and systemic corticosteroids. Three out of 4 patients had no recurrence for at least 1 year since the first presentation. IgAN is a rare but important systemic association to be considered in ocular inflammatory conditions. Timely recognition and comanagement of the disease with nephrologist could reduce disease morbidity.
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Affiliation(s)
- Hnin Hnin Oo
- Department of Ophthalmology, National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore
| | - Mun Yoong Darren Choy
- Department of Ophthalmology, National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore
| | - Atul Arora
- Department of Ophthalmology, Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - See Cheng Yeo
- Department of Renal Medicine, Tan Tock Seng Hospital, Singapore; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Raja Ramachandran
- Department of Nephrology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Vishali Gupta
- Department of Ophthalmology, Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Peter McCluskey
- Save Sight Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.
| | - Rupesh Agrawal
- Department of Ophthalmology, National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore; Singapore Eye Research Institute, Singapore; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Duke NUS Medical School, Singapore.
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2
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Kwan JT, Lanzo E, Ramsey DJ, Kalra A, Athappilly-Rolfe GK. Papilledema and retinopathy lead to diagnosis of IgA nephropathy: a case report. THERAPEUTIC ADVANCES IN RARE DISEASE 2023; 4:26330040231152957. [PMID: 37181072 PMCID: PMC10032434 DOI: 10.1177/26330040231152957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 01/04/2023] [Indexed: 05/16/2023]
Abstract
This case features a young healthy male who was diagnosed with immunoglobulin A (IgA) nephropathy after presenting with blurry vision that was caused by hypertensive retinopathy and papilledema. In this report, we examine the relationship between hypertension and increased intracranial pressure (ICP), along with the ocular signs of IgA nephropathy that may present in the setting of kidney disease.
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Affiliation(s)
- James T. Kwan
- Department of Ophthalmology, Tufts Medical Center,
Boston, MA, USA
- Department of Ophthalmology, Lahey Hospital & Medical
Center, Burlington, MA, USA
| | - Erin Lanzo
- Department of Ophthalmology, Tufts Medical Center,
Boston, MA, USA
- Department of Ophthalmology, Lahey Hospital & Medical
Center, Burlington, MA, USA
| | - David J. Ramsey
- Department of Ophthalmology, Tufts Medical Center,
Boston, MA, USA
- Department of Ophthalmology, Lahey Hospital & Medical
Center, Burlington, MA, USA
| | - Aarti Kalra
- Department of Pathology, Lahey Hospital & Medical
Center, Burlington, MA, USA
| | - Geetha K. Athappilly-Rolfe
- Department of Ophthalmology, Atrius Health, Medford MA,
USA
- Department of Ophthalmology, Lahey Hospital & Medical
Center, Burlington, MA, USA
- Harvard Vanguard Medical Associates Medford, Medford,
MA, USA
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3
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El Matri K, Amoroso F, Zambrowski O, Miere A, Souied EH. Multimodal imaging of bilateral ischemic retinal vasculopathy associated with Berger's IgA nephropathy: case report. BMC Ophthalmol 2021; 21:204. [PMID: 33964916 PMCID: PMC8106839 DOI: 10.1186/s12886-021-01935-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 04/06/2021] [Indexed: 12/17/2022] Open
Abstract
Background Berger’s IgA nephropathy (IgAN) is the most common primary glomerulonephritis. However, some rare cases of retinal manifestations have been described, with only two cases of retinal vasculopathy reported in the literature. Here we report an uncommon case of bilateral ischemic retinal vasculopathy associated with Berger IgAN, evaluated with complete multimodal imaging including ultra-wide field (UWF) imaging and swept source optical coherence tomography angiography (SS-OCTA). Case presentation A 51-year-old woman with a history of Berger’s IgA nephropathy complained of visual impairment in both eyes. Fundus examination showed bilateral peripapillary arterial attenuation and perivascular sheathing, associated to perifoveal telangiectatic lesions. There was a central scotoma in the perimetry of the right eye and peripheral visual field defect in the left eye. Full-field electroretinogram revealed significantly reduced oscillatory potentials. Spectral domain optical coherence tomography showed multiple focal areas of thinning of the inner retina, indicating long-lasting vascular occlusion lesions. UWF fluorescein angiography showed the presence of bilateral vasculitis, diffuse capillary leakage, macular ischemia and telangiectasia. SS-OCTA better highlighted the macular ischemia and vascular anomalies layer-by-layer. Conclusions Retinal vasculopathy is a very rare condition observed in IgA nephropathy. To our knowledge, this is the first report of complete multimodal functional and structural imaging. UWF imaging was very useful for accurate and comprehensive disease assessment, and OCTA was able to assess posterior pole vascular lesions.
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Affiliation(s)
- Khaled El Matri
- Department of Ophthalmology, Centre Hospitalier Intercommunal de Créteil, University Paris Est Créteil, 40 Avenue de Verdun, 94000, Créteil, France.,Department B, Institut Hedi Rais d'ophtalmologie de Tunis, University Tunis - El Manar, Boulevard 9 Avril 1938, 1006, Tunis, Tunisia
| | - Francesca Amoroso
- Department of Ophthalmology, Centre Hospitalier Intercommunal de Créteil, University Paris Est Créteil, 40 Avenue de Verdun, 94000, Créteil, France
| | - Olivia Zambrowski
- Department of Ophthalmology, Centre Hospitalier Intercommunal de Créteil, University Paris Est Créteil, 40 Avenue de Verdun, 94000, Créteil, France
| | - Alexandra Miere
- Department of Ophthalmology, Centre Hospitalier Intercommunal de Créteil, University Paris Est Créteil, 40 Avenue de Verdun, 94000, Créteil, France
| | - Eric H Souied
- Department of Ophthalmology, Centre Hospitalier Intercommunal de Créteil, University Paris Est Créteil, 40 Avenue de Verdun, 94000, Créteil, France.
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Hernanz I, Larque AB, Quintana LF, Espigol-Frigole G, Espinosa G, Adan A, Sainz-de-la-Maza M. Scleritis and sclerokeratitis associated with IgA vasculitis: A case series. Am J Ophthalmol Case Rep 2021; 22:101100. [PMID: 33997470 PMCID: PMC8093897 DOI: 10.1016/j.ajoc.2021.101100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 02/17/2021] [Accepted: 04/12/2021] [Indexed: 10/30/2022] Open
Abstract
Purpose To describe a case series of scleritis associated with IgA vasculitis (IgAV) at a tertiary referral center. Observations Three men with scleritis associated with IgAV were identified: one with anterior scleritis alone, one with anterior scleritis and peripheral ulcerative keratitis (sclerokeratitis), and one with anterior and posterior scleritis. Visual acuity was preserved except from the patient who developed posterior scleritis. Ocular pain was the main symptom at presentation. All patients had a previous history of palpable purpura, but only one was aware of his underlying IgAV. Laboratory results revealed microhematuria and proteinuria with normal urinary β2 microglobulin levels and negative serum ANCAs. Skin or kidney biopsy demonstrated leukocytoclastic vasculitis or glomerulonephritis with dominant IgA immune deposits. Conclusions and Importance Although uncommon, IgAV should be included in the differential diagnosis of anterior scleritis alone or associated with peripheral ulcerative keratitis or posterior scleritis, even in systemically asymptomatic patients. Urinalysis should not be underestimated in assessment of scleritis to detect early stages of glomerular disease. Scleritis may be the first manifestation whose study may lead to the diagnosis of IgAV. Multidisciplinary approach is necessary to prevent irreversible organ damage such as renal failure.
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Affiliation(s)
- I Hernanz
- Clinical Institute of Ophthalmology, Hospital Clinic of Barcelona, Barcelona, Spain
| | - A B Larque
- Department of Pathology, Hospital Clinic of Barcelona, Barcelona, Spain
| | - L F Quintana
- Department of Nephrology and Renal Transplantation, Centro de Referencia en Enfermedad Glomerular Compleja del Sistema Nacional de Salud (CSUR), Hospital Clinic of Barcelona, Barcelona, Spain.,August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain.,Department of Medicine, University of Barcelona, Barcelona, Spain
| | - G Espigol-Frigole
- Department of Autoimmune Diseases, Hospital Clinic of Barcelona, Barcelona, Spain.,August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - G Espinosa
- Department of Autoimmune Diseases, Hospital Clinic of Barcelona, Barcelona, Spain.,August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain.,Department of Medicine, University of Barcelona, Barcelona, Spain
| | - A Adan
- Clinical Institute of Ophthalmology, Hospital Clinic of Barcelona, Barcelona, Spain.,August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain.,Department of Medicine, University of Barcelona, Barcelona, Spain
| | - M Sainz-de-la-Maza
- Clinical Institute of Ophthalmology, Hospital Clinic of Barcelona, Barcelona, Spain.,August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
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Gupta V, Jamil M, Luthra S, Puthalath AS. Alport syndrome with bilateral simultaneous anterior and posterior lenticonus with severe temporal macular thinning. BMJ Case Rep 2019; 12:e229554. [PMID: 31420426 PMCID: PMC6700549 DOI: 10.1136/bcr-2019-229554] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/19/2019] [Indexed: 11/04/2022] Open
Abstract
Alport syndrome (AS) is a hereditary disease with various modes of inheritance, X-linked being the the most common. Anterior lenticonus is the characteristic abnormality along with perimacular and peripheral fleck retinopathy. Our two cases of AS had simultaneous anterior and posterior lenticonus with severe temporal macular thinning on optical coherence tomography with no specific renal symptomatology and were diagnosed as AS without any invasive renal biopsy. First patient was a 19-year-old man who presented with compound myopia due to bilateral anterior and posterior lenticonus with perimacular fleck retinopathy and lozenge sign and bilateral moderate sensorineural hearing loss (SNHL). Second patient was a 24-year-old man who presented with difficulty in vision due to bilateral anterior and posterior lenticonus with bilateral severe SNHL. Our cases emphasise the crucial role of an ophthalmologist in diagnosing AS before the onset of renal symptoms and prompting further nephrological work-up in the patient or the carrier.
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Affiliation(s)
- Vinita Gupta
- Ophthalmology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Mahsa Jamil
- Ophthalmology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Saurabh Luthra
- Ophthalmology, Drishti Eye Institute, Dehradun, Uttarakhand, India
| | - Athul S Puthalath
- Ophthalmology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
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Rueda-Rueda T, Sánchez-Vicente JL, Moruno-Rodríguez A, Molina-Socola FE, Contreras-Díaz M, Vizuete-Rodríguez L, Castilla-Martino M, Sáez-Ortega L, Muñoz-Morales A, Martínez-Borrego AC, Parra-Oviedo E, Medina-Tapia A, López-Herrero F. Unilateral uveitis associated with IgA nephropathy. ACTA ACUST UNITED AC 2017; 92:598-601. [PMID: 28343747 DOI: 10.1016/j.oftal.2017.02.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Revised: 02/11/2017] [Accepted: 02/14/2017] [Indexed: 11/17/2022]
Abstract
CASE REPORT The case is presented of a 42 year-old man with episodes of unilateral uveitis in his right eye. Ophthalmic examination showed a granulomatous anterior uveitis with vitritis. Systemic investigations revealed non-nephrotic proteinuria and microhaematuria. A renal biopsy showed IgA nephropathy. DISCUSSION Uveitis and glomerulonephritis may have common immunological pathogenesis. IgA nephropathy should be a differential diagnosis in patients with uveitis and nephropathy.
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Affiliation(s)
- T Rueda-Rueda
- Oftalmología, Hospital Universitario Virgen del Rocío, Sevilla, España
| | | | | | - F E Molina-Socola
- Oftalmología, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - M Contreras-Díaz
- Oftalmología, Hospital Universitario Virgen del Rocío, Sevilla, España
| | | | | | - L Sáez-Ortega
- Oftalmología, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - A Muñoz-Morales
- Oftalmología, Hospital Universitario Virgen del Rocío, Sevilla, España
| | | | - E Parra-Oviedo
- Oftalmología, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - A Medina-Tapia
- Oftalmología, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - F López-Herrero
- Oftalmología, Hospital Universitario Virgen del Rocío, Sevilla, España
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Yan Y, Zhang Q. Bilateral Posterior Scleritis Presenting as the First Manifestation of Immunoglobulin A Nephropathy: Case Report and Review of the Literature. Ocul Immunol Inflamm 2014; 24:43-8. [PMID: 25290901 DOI: 10.3109/09273948.2014.964420] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE We describe a case of posterior scleritis presenting as the first manifestation in a Chinese patient with immunoglobin A nephropathy (IgAN). METHODS Retrospective review of our patient and review of the published case reports from PubMed search. RESULTS A 43-year-old woman developed bilateral posterior scleritis. Microscopic hematuria and proteinuria was found by urinalysis, and a kidney biopsy revealed IgAN. The posterior scleritis was resolved with oral prednisolone. For the review, 12 cases of episcleritis (70.6%), 4 cases of scleritis (23.5%), and 1 case of posterior scleritis (5.9%) associated with IgAN were analyzed. Five patients (29.4%) had scleritis or episcleritis as the first presenting manifestation. CONCLUSIONS Posterior scleritis may be the first manifestation of IgAN in a patient. For any adult patient with scleral/episcleral inflammation, urinalysis should be done to rule out IgAN.
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Affiliation(s)
- Yan Yan
- a Department of Ophthalmology , Ruijin Hospital, Shanghai Jiaotong University School of Medicine , Shanghai , China
| | - Qiong Zhang
- a Department of Ophthalmology , Ruijin Hospital, Shanghai Jiaotong University School of Medicine , Shanghai , China
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