Optic neuropathy in uremia: an interdisciplinary emergency.
Optic neuropathy in uremia is rare. Although the consequences of optic neuropathy-blindness or substantial loss of vision-are devastating, only a few cases have been reported by way of single case reports and case series studies. The reported patients are heterogeneous with regard to the cause of neuropathy. We report the case of a patient with uremic optic neuropathy and summarize the other cases reported in the literature so far. Based on the data available from these reports, we propose a classification system, which includes nonischemic neurotoxic uremic optic neuropathy; ischemic optic neuropathy, more specifically anterior ischemic optic neuropathy; and optic neuropathy as a result of drug side effects, benign intracranial hypertension, and optic neuritis. The immediate institution of dialysis and corticosteroid therapy and correction of anemia and relative hypotension can optimize the chances of visual recovery for these patients. Close collaboration among nephrologists, ophthalmologists, and neurologists is important in this interdisciplinary emergency.
Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. wolfgang@post.harvard.edu
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WC
Winkelmayer
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Eigner
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O
Berger
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Grisold
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Leithner
D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D064420:Drug-Related Side Effects and Adverse Reactions; D004632:Emergency Medical Services; D006801:Humans; D007511:Ischemia / Q000150:complications; D008297:Male; D008875:Middle Aged; D009900:Optic Nerve / Q000098:blood supply; D009901:Optic Nerve Diseases / Q000145:classification / Q000150:complications* / Q000188:drug therapy / Q000209:etiology; D010348:Patient Care Team; D011239:Prednisolone / Q000627:therapeutic use; D006435:Renal Dialysis; D017211:Treatment Failure; D014511:Uremia / Q000150:complications* / Q000628:therapy
D000893:Anti-Inflammatory Agents; D011239:Prednisolone