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A 26-year-old man with renal failure and vision loss
Digital Journal of Ophthalmology 2008
Volume 14, Number 13
July 12, 2008
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Tarek Alasil | University of Southern California
Mario Meallet | University of Southern California
History
A 26-year-old Latino man with no past medical history of diabetes or hypertension presented to the emergency room complaining of nausea, back pain, fatigue, cough with yellowish sputum, and pleuritic chest pain. The review of systems revealed decreased urinary output.

The vital signs upon presentation are summarized in Table 1. The patient’s physical exam showed bilateral costovertebral angle tenderness, and his laboratory tests are summarized in Table 2. A computed tomography scan was negative for nephrolithiasis, an electrocardiogram and an echocardiogram showed left ventricular hypertrophy, and a renal ultrasound showed small and echogenic kidneys bilaterally.

The patient was diagnosed with nephrotic syndrome and end-stage renal disease (ESRD). An extensive workup was carried out to define the etiology of the renal failure (Table 3). A kidney biopsy was not warranted given the ESRD and the potential complications associated with the procedure. His anemia was though to be anemia of chronic disease secondary to renal failure and his dyslipidemia is consistent with nephrotic syndrome.

He was started on hemodialysis three times a week, plus Darbepoetin Alfa and Simvastatin for anemia and dyslipidemia, respectively. The patient was compliant with the hemodialysis schedule and the prescribed medications.

One year later, the patient presented to the emergency room complaining of severe headache and vomiting followed by sudden vision loss bilaterally. His vital signs are summarized in Table 4. A computed tomography scan of the head showed no evidence of bleeding, midline shift, or mass. A lumbar puncture was performed and acute meningitis was ruled out.
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Table 1
Vital signs at initial presentation

Table 2
Laboratory Tests

Table 3
Laboratory work-up for cause of renal failure

Table 4
Vital signs at second presentation