title: [Case report of a recurrent nephrotic syndrome patient with sudden onset of blindness during treatment with cyclosporin A].
abstract: We report a case of recurrent nephrotic syndrome with transient blindness after taking cyclosporin A (CsA). Renal biopsy showed minimal change of nephrotic syndrome and the patient was treated with predonisolone (PSL) and cyclophosphamide leading to remission of nephrosis. CsA was given to the patient. Because of recurrence of nephrotic syndrome after tapering off PSL to 5 mg a day, 12 days after taking CsA, the patient complained of sudden onset of left eye blindness lasting for 30 minutes. When the patient visited our hospital, the disturbed vision had recovered already and there were no abnormal neurological findings, such as tremors and seizures. Funduscopic examination revealed no evidence of abnormalities and brain computerized axial tomography was unremarkable. From these findings, we predicted that constriction of an artery and temporarily formed thromboembolization in an eyeground artery had caused the sudden vision disturbance. Even though there is a high incidence of thrombotic complications in cases of nephrotic syndrome, we believe that vascular constriction and formation of thrombi in the eyeground artery of the case were mediated by the pathogistic effects of CsA. Because actions in association with CsA may produce constriction of small arteries, there by decreasing blood flow, initiating coagulopathy and causing endothelial cell damage, all these effects may lead to the formation of thrombo-embolic complications. In addition, when using CsA for the treatment of nephrotic syndrome, anti-platelets and/or anti-coagulant medicines should be concomitantly prescribed to avoid the thrombo-embolic complications.
authors.affiliation: Clinic of Internal Medicine, Center Kita Ito Clinic, Yokohama, Japan.
authors.forename: S
authors.initials: S
authors.lastname: Ito
authors.forename: M
authors.initials: M
authors.lastname: Hosaka
authors.forename: M
authors.initials: M
authors.lastname: Beppu
authors.forename: T
authors.initials: T
authors.lastname: Nomura
authors.forename: J
authors.initials: J
authors.lastname: Uchida
mesh_terms: D000328:Adult; D001766:Blindness / Q000139:chemically induced*; D016572:Cyclosporine / Q000008:administration & dosage / Q000009:adverse effects*; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000009:adverse effects*; D008297:Male; D009404:Nephrotic Syndrome / Q000150:complications*; D012008:Recurrence
chemical_list: D007166:Immunosuppressive Agents; D016572:Cyclosporine