Uremic Optic Neuropathy as the Initial Manifestation of Advanced Chronic Kidney Disease

Uremic optic neuropathy (UON) is a rare but potentially reversible complication of advanced kidney failure characterized by optic disc edema and visual decline that improves with dialysis. We report the case of a 45-year-old man with no prior diagnosis of chronic kidney disease who presented with 3 months of progressive bilateral blurry vision, eye pain, and exertional fatigue. Ophthalmologic examination revealed bilateral optic disc edema with reduced visual acuity. Laboratory evaluation showed profound azotemia (blood urea nitrogen 182.9 mg/dL; creatinine 29.5 mg/dL), hyperkalemia, anemia, metabolic acidosis, and nephrotic-range proteinuria. Neuroimaging excluded intracranial hemorrhage, mass lesions, and other structural abnormalities. Renal imaging demonstrated bilaterally small echogenic kidneys and a horseshoe kidney, consistent with chronic parenchymal disease. UON was considered owing to severe azotemia and absence of alternative etiologies. Following dialysis initiation, the patient experienced rapid improvement in visual symptoms with corresponding reduction in optic disc edema. This case highlights UON as an uncommon but reversible manifestation of severe uremia and underscores the importance of assessing kidney function in patients presenting with unexplained optic neuropathy.