Dialysis improved his vision !

This case was contributed by

Dr Irshad Sirwal 

Consultant Nephrologist

King AbdulAziz Specialist Hospital Taif KSA

Clinical scenario:  
A 48-year-old male presented with history of progressive visual loss  in both eyes of two weeks duration .He also complained of generalized fatigue of same duration .He denied any history of  trauma or offending drug intake . The patient was non diabetic , normotensive and denied any other systemic illness .

Examination:
The patient was conscious and oriented. He had normal vitals . Icterus, lymphadenopathy and edema were absent. The  systemic examination were normal. There was no neurodefecit
Eye examination :
Patients visual acuity was reduced to finger counting in both eyes .
The external examination of eye was normal  and all ocular muscles were normal .
Fundus examination was normal too .
Evaluation: 
He had hemoglobin of 10.2 gm/dl , white cell count and erythrocyte sedimentation rate were normal as well. Tests of liver function were normal .Renal function tests revealed Urea of  215 mg/dl and creatinine levels were 15 mg /dl    His chest X-ray was normal.
The ultrasound examination showed  reduced size of both kidneys and no features of obstructive uropathy was seen .The cortico medullary differentiation was lost on both sides  .The over all features were suggestive of chronic kidney disease The liver, gallbladder and other organs were normal.

Fig.1  The USG shows shrunken kidney  Yellow circle shows what  the size of kidney should have been

COURSE :  
Patient was given Hemodialysis and he had progressive improvement of his vision over a period of three weeks . 

Teaching message :
Blindness can be first presentation of chronic kidney disease and is reversible with dialysis  
            
For further Reading click the Link: Chronic Kidney Disease