Severe bilateral visual loss as the first sign of IgA nephropathy

• Published in: Arquivos brasileiros de oftalmologia Vol. 86; no. 6
• Main Authors: Cunha, Leonardo Provetti, Defina, Raphael Lucas Sampaio, Preti, Rony Carlos, Costa-Cunha, Luciana Virgínia Ferreira, Zacharias, Leandro Cabral, Hokazono, Kenzo, Monteiro, Mário Luiz Ribeiro
• Format: Journal Article
• Language: Portuguese
• Published: Conselho Brasileiro de Oftalmologia 2023
• Subjects: OPHTHALMOLOGY; Glomerulonephritis; Hypertension; Systemic arterial hypertension; IGA; Retinopatia hipertensiva; Nefropatia por IgA; malignant; Edema macular; Hipertensão arterial sistêmica; Berger’s disease; Hypertensive retinopathy; Tomography; Macular edema; optical coherence; Doença de Berger; Tomografia de coerência óptica; Hipertensão maligna
• DOI: 10.5935/0004-2749.2021-0314
• ISSN: 1678-2925

ABSTRACT 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.