Bilateral Optic Atrophy in a Young Patient With Chronic Anaemia Secondary to End-Stage Renal Disease

Nor Hasnida Ab Gani,Nurul Ain Masnon,Mohtar Ibrahim,Amirah Hassan,Wan-Hazabbah Wan Hitam

doi:10.7759/cureus.13969

Abstract

End-stage renal disease (ESRD) is associated with a number of serious complications, including increased cardiovascular disease, anaemia and metabolic bone disease. Optic atrophy secondary to chronic anaemia in ESRD is rare. We report a case of bilateral optic atrophy in a young patient with chronic anaemia secondary to ESRD. A 23-year-old lady with ESRD, presented with progressive blurring of vision in her left eye for a period of six months. Visual acuity in the left eye was counting finger and the right eye was 6/6. Left optic nerve functions were significantly reduced. Bilateral anterior segments and intraocular pressure were normal. Funduscopy showed bilateral pale disc with arteriolar attenuation. The infective, autoimmune and demyelinating screening were negative. Serial full blood count indicated low haemoglobin and haematocrit value. The full blood picture revealed normocytic normochromic anaemia. Neuroimaging was normal. The patient was diagnosed as having bilateral optic atrophy secondary to chronic anaemia due to ESRD. Chronic anaemia is a potential cause of optic atrophy in a young patient with chronic disease. Management of anaemia in such cases is crucial to prevent irreversible complications including optic atrophy and blindness.

Highlights

End-stage renal disease (ESRD) has emerged as a global public health problem
We report a case of bilateral optic atrophy in a young patient with chronic anaemia secondary to ESRD
ESRD patients should receive optimal treatment to reduce their morbidity and mortality. This case report demonstrates the importance of anaemia management in ESRD patients, in order to avoid irreversible sequelae such as bilateral optic atrophy in young patients

Summary

Introduction

End-stage renal disease (ESRD) has emerged as a global public health problem. The Asian population has the highest prevalence of ESRD in the world. The kidney function deteriorated further and she required continuous ambulatory peritoneal dialysis (CAPD) four times daily On examination, her visual acuity was 6/6 on the right eye and counting finger on the left eye. The full blood picture showed normocytic normochromic anaemia Her average serum iron was 4.7-13.4 μmol/L, with low total iron binding capacity 25.6-33.1 μmol/L and unbound iron binding capacity range was 12.7-28.4 μmol/L. Magnetic resonance imaging (MRI) brain and orbit revealed normal brain parenchyma with no space occupying lesion hydrocephalus or periventricular plaques We diagnosed this patient with bilateral optic disc atrophy secondary to chronic anaemia due to ESRD. The patient was given subcutaneous erythropoiesis-stimulating agent 4000IU three times per week for anaemia treatment since one month on dialysis She was given tablet ferrous fumarate, vitamin B complex, folic acid 5 mg, calcium carbonate and potassium chloride. Serial followup demonstrated the visual acuity remains the same and the visual field was noted to further worsen over the right eye

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