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[Subretinal neovascular membranes in membranoproliferative glomerulonephritis type II]
Background:
So called 'dense deposits' in the retina of a patient suffering from membranoproliferative glomerulonephritis type II (MPGN II) were first demonstrated in 1989. Appearence of subretinal neovascular membranes associated with MPGN II in three patients was described in 1990.
Patient And Methods:
We present a 45-year-old male patient, whose insufficiency of the kidney due to a membranoproliferative glomerulonephritis type II required peritoneal dialysis and later transplantation. In both eyes fundus examination revealed typical disseminated, partly confluencing, drusen-like 'dense deposits' and exsudative degeneration of the macula due to subretinal neovascular membranes. Visual acuity was less than 20/400 and visual fields were reduced to small excentrics islands. There was an atrophy of the optic nerve with nearly extinguished VEP in both eyes.
Conclusion:
Flecked changes of the retina called 'dense deposits' associated with membranoproliferative glomerulonephritis type II have to be differentiated in particular from drusen, as well as metabolic-toxic and degenerative retinopathy. Development of subretinal neovascular membranes is attributed to altered retinal pigment epithelium, similar to age-related macular degeneration. An atrophy of the optic nerve associated with this disease has not been described so far. It is possible that vascular damage because of hypertensive changes due to renal dysfunction is the reason for the optic nerve atrophy. With another hypothesis this could be caused by intraocular pressure due to a risen flow of water into the vitreous cavity following the altered osmotic gradient after peritoneal dialysis.
Insights
Dense deposits in the retina are linked to membranoproliferative glomerulonephritis type II (MPGN II). This condition can cause vision loss and optic nerve atrophy, requiring differentiation from other retinal diseases.
Area of Science:
- Ophthalmology
- Nephrology
- Medical Retina
Background:
- Membranoproliferative glomerulonephritis type II (MPGN II) is a kidney disease.
- Retinal 'dense deposits' associated with MPGN II were first described in 1989.
- Subretinal neovascular membranes in MPGN II patients were reported in 1990.
Observation:
- A 45-year-old male with MPGN II experienced kidney failure requiring dialysis and transplantation.
- Fundus examination revealed drusen-like 'dense deposits' and macular degeneration due to subretinal neovascular membranes.
- The patient presented with severe vision loss, reduced visual fields, and optic nerve atrophy.
Findings:
- 'Dense deposits' in MPGN II retinopathy must be distinguished from drusen and other retinopathies.
- Subretinal neovascular membranes in MPGN II may arise from altered retinal pigment epithelium.
- Optic nerve atrophy, not previously described in MPGN II, was observed.
Implications:
- Optic nerve atrophy may result from hypertensive vascular changes due to renal dysfunction.
- Alternatively, optic nerve atrophy could be linked to intraocular pressure changes post-peritoneal dialysis.
- This case highlights the complex ocular manifestations of MPGN II and its potential impact on optic nerve health.