BILATERAL SEROUS RETINAL DETACHMENT AS A PRESENTING SIGN OF MEMBRANOUS NEPHROPATHY – A CASE REPORT
DR NATASHA C MUTHUKRISHNA GRIFFITHS1, DR SASKIA M LEIBOWITZ1, DR JEREMY E FRAZIER1, DR SHYAM DHEDA1, DR KEN-SOON TAN1, DR BIBIANA TIE2
1Logan Hospital, Meadowbrook, Australia
2Princess Alexandra Hospital, Australia
Background: The aim of this report is to present a rare case of bilateral serous retinal detachment (SRD) as a presenting sign of nephrotic syndrome.
Case Report: A 68-year-old man with no known kidney disease presented with sudden-onset bilateral visual blurring and new nephrotic syndrome, characterised by generalised oedema, hypoalbuminaemia (16g/L), and nephrotic-range proteinuria (PCR 1200g/mol). He had a concurrent acute kidney injury requiring dialysis due to hyperkalaemia (6.3 mmol/L), uraemia (53.2 mmol/L) and refractory fluid overload. Computed Tomography imaging revealed non-obstructing calculi in both kidneys. Initial serology revealed positive ANA (1:640 speckled), SSA and SSB, and depressed C3 (0.65g/L). Optical coherence tomography scans revealed bilateral SRD secondary to nephrotic syndrome.
The patient proceeded to a kidney biopsy which showed mild glomerular ischaemia only. Glucocorticoids were empirically commenced for presumed minimal change disease, awaiting electron microscopy results. Over the next six weeks, there was improvement in visual acuity, kidney function (Cr 159µmol/L) and proteinuria (PCR 174g/mol). Electron microscopy demonstrated diffuse podocyte effacement and subepithelial and intramembranous deposits, consistent with membranous nephropathy. Serum PLA2R antibodies were not detected. Two months later, the patient had worsening SRD coinciding with worsening proteinuria (PCR 752g/mol). A repeat kidney biopsy showed PLA2R-negative membranous glomerulonephritis with crescents and positive IgG1 and IgG3 segmental granular staining in capillary loops on immunofluorescence.
The provisional diagnosis was membranous nephropathy secondary to Sjogren’s syndrome. The patient is planned for treatment with the modified Ponticelli regimen.
Conclusions: Bilateral SRD is a rare presenting sign for nephrotic syndrome and a potential marker of response to therapy. Prompt recognition and management of the underlying nephrotic syndrome are essential for restoration of visual function and prevention of long-term complications.
Presentation Slides PDF – Click here
Biography:
Dr Natasha C Muthukrishna Griffiths is a Basic Physician Trainee Registrar with an interest in Nephrology.