title: Sudden Visual Deterioration as the First Symptom of Chronic Kidney Failure.
abstract: OBJECTIVE
  We report here a unique case of a sudden loss of vision as the first symptom of an advanced chronic nephropathy.
  
  
  RESULTS
  A 25-year-old man was referred to the Department of Ophthalmology with sudden visual deterioration presumptively diagnosed as bilateral retinitis. The patient had never been under any medical care before and had never had any clinical signs of any chronic disease. He underwent an ophthalmic examination with optical coherence tomography (OCT). Based on the clinical features, OCT scans and systemic blood pressure (BP) assessment (225/145 mm Hg), the patient was definitely diagnosed with hypertensive retinopathy and choroidopathy due to hypertensive crisis. After urgent diagnostic procedures, the patient was diagnosed with a chronic kidney disease at stage 5 in the course of chronic glomerulonephritis. Immediately, a renal replacement therapy was started and the patient was qualified for renal transplantation.
  
  
  CONCLUSIONS
  Adolescents with an unclear picture of retinal lesions, who have neither a history nor clinical signs of a systemic disease, should undergo careful systemic screening with BP assessment. A sudden deterioration of vision may be the first symptom of a previously undiagnosed severe systemic disease (very rare chronic) that requires immediate treatment.
authors.affiliation: Departments of Ophthalmology, Jagiellonian University Medical College, Kraków, Poland.
authors.forename: Weronika
authors.initials: W
authors.lastname: Pociej-Marciak
authors.affiliation: Departments of Ophthalmology, Jagiellonian University Medical College, Kraków, Poland.
authors.forename: Izabella
authors.initials: I
authors.lastname: Karska-Basta
authors.affiliation: Nephrology, Jagiellonian University Medical College, Kraków, Poland.
authors.forename: Marek
authors.initials: M
authors.lastname: Kuźniewski
authors.affiliation: Departments of Ophthalmology, Jagiellonian University Medical College, Kraków, Poland.
authors.forename: Agnieszka
authors.initials: A
authors.lastname: Kubicka-Trząska
authors.affiliation: Departments of Ophthalmology, Jagiellonian University Medical College, Kraków, Poland.
authors.forename: Bożena
authors.initials: B
authors.lastname: Romanowska-Dixon
keywords: Chronic renal failure; Hypertensive choroidopathy; Hypertensive crisis; Hypertensive retinopathy