Short communication
Retinal manifestations in patients with complement-mediated membranoproliferative glomerulonephritis
Manifestaciones retinianas en pacientes con glomerulonefritis membranoproliferativa mediada por complemento
Read
2
Timeswas read the article
1
Total PDF
1
Total HTML
Share statistics
array:24 [ "pii" => "S217357941830166X" "issn" => "21735794" "doi" => "10.1016/j.oftale.2018.11.001" "estado" => "S300" "fechaPublicacion" => "2019-02-01" "aid" => "1372" "copyright" => "Sociedad Española de Oftalmología" "copyrightAnyo" => "2018" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Arch Soc Esp Oftalmol. 2019;94:95-9" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S0365669118302235" "issn" => "03656691" "doi" => "10.1016/j.oftal.2018.06.013" "estado" => "S300" "fechaPublicacion" => "2019-02-01" "aid" => "1372" "copyright" => "Sociedad Española de Oftalmología" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Arch Soc Esp Oftalmol. 2019;94:95-9" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 66 "formatos" => array:2 [ "HTML" => 51 "PDF" => 15 ] ] "es" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Comunicación corta</span>" "titulo" => "Manifestaciones retinianas en pacientes con glomerulonefritis membranoproliferativa mediada por complemento" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "95" "paginaFinal" => "99" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Retinal manifestations in patients with complement-mediated membranoproliferative glomerulonephritis" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figura 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 698 "Ancho" => 1255 "Tamanyo" => 167658 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Tomografía de coherencia óptica de dominio espectral mostrando los depósitos drusenoides localizados por debajo del epitelio pigmentario de la retina.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "L. de-Pablo-Gómez-de-Liaño, I. Cañas Zamarra, J.I. Fernández-Vigo, M. Fernández Vidal, C. Navarro-Perea, T. Cavero Escribano" "autores" => array:6 [ 0 => array:2 [ "nombre" => "L." "apellidos" => "de-Pablo-Gómez-de-Liaño" ] 1 => array:2 [ "nombre" => "I." "apellidos" => "Cañas Zamarra" ] 2 => array:2 [ "nombre" => "J.I." "apellidos" => "Fernández-Vigo" ] 3 => array:2 [ "nombre" => "M." "apellidos" => "Fernández Vidal" ] 4 => array:2 [ "nombre" => "C." "apellidos" => "Navarro-Perea" ] 5 => array:2 [ "nombre" => "T." "apellidos" => "Cavero Escribano" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S217357941830166X" "doi" => "10.1016/j.oftale.2018.11.001" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S217357941830166X?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0365669118302235?idApp=UINPBA00004N" "url" => "/03656691/0000009400000002/v2_202201280714/S0365669118302235/v2_202201280714/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S2173579418301282" "issn" => "21735794" "doi" => "10.1016/j.oftale.2018.06.012" "estado" => "S300" "fechaPublicacion" => "2019-02-01" "aid" => "1361" "copyright" => "Sociedad Española de Oftalmología" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Arch Soc Esp Oftalmol. 2019;94:100-4" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Short communication</span>" "titulo" => "Topical insulin in neurotrophic keratopathy after resection of acoustic neuroma" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "100" "paginaFinal" => "104" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Insulina tópica en queratopatía neurotrófica tras resección de neurinoma del acústico" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1581 "Ancho" => 1867 "Tamanyo" => 213906 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">(a) Persistence of epithelial defect maintaining similar size (6.4<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>6.2<span class="elsevierStyleHsp" style=""></span>mm) one week after initiating autologous plasma treatment; (b) five days after adding topical insulin, the de-epithelized area size diminished significantly (2.4<span class="elsevierStyleHsp" style=""></span>mm in the largest horizontal diameter<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>2.9<span class="elsevierStyleHsp" style=""></span>mm vertical); (c) three days later a somewhat larger defect persisted (3.1<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>3.4<span class="elsevierStyleHsp" style=""></span>mm) for which reason the therapeutic contact lens was utilized again; (d) two weeks after initiating topical insulin treatment, the complete epithelization of the defect was finally achieved.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "V. Galvis, C.A. Niño, A. Tello, J.M. Grice, M.A. Gómez" "autores" => array:5 [ 0 => array:2 [ "nombre" => "V." "apellidos" => "Galvis" ] 1 => array:2 [ "nombre" => "C.A." "apellidos" => "Niño" ] 2 => array:2 [ "nombre" => "A." "apellidos" => "Tello" ] 3 => array:2 [ "nombre" => "J.M." "apellidos" => "Grice" ] 4 => array:2 [ "nombre" => "M.A." "apellidos" => "Gómez" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0365669118301849" "doi" => "10.1016/j.oftal.2018.06.003" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0365669118301849?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173579418301282?idApp=UINPBA00004N" "url" => "/21735794/0000009400000002/v1_201902010639/S2173579418301282/v1_201902010639/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S2173579418301543" "issn" => "21735794" "doi" => "10.1016/j.oftale.2018.10.003" "estado" => "S300" "fechaPublicacion" => "2019-02-01" "aid" => "1381" "copyright" => "Sociedad Española de Oftalmología" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Arch Soc Esp Oftalmol. 2019;94:90-4" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Short communication</span>" "titulo" => "Inflammatory juvenile compound nevi: A melanoma is not all that it appears to be" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "90" "paginaFinal" => "94" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Nevus compuesto inflamatorio juvenil: no es melanoma todo lo que parece" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0015" "etiqueta" => "Fig. 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 2081 "Ancho" => 2091 "Tamanyo" => 1248427 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Optical microscopy with hematoxylin-eosine staining (H&E): (A) panoramic appearance of the lesion (×50 zoom) constituted by variably pigmented hyper-cellular areas (green bracket) alternating with cystic areas (blue arrow). (B) Lesion section with greater enlargement (×200) showing nevic cells organized in epithelial (yellow arrow) and sub-epithelial clusters (red arrow), enabling the lesion to be defined as composite nevus. (C) Lesion section (×200) showing a large amount of chronic inflammatory infiltrate (lymphocytes and plasmatic cells) (yellow arrow) rich in eosinophiles (black arrow).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "G. García de Oteyza, J. Betancourt, M. Benedetti Sandner, K.A. Vázquez-Romo, I. Hernández-Ayuso, N. Ramos-Betancourt" "autores" => array:6 [ 0 => array:2 [ "nombre" => "G." "apellidos" => "García de Oteyza" ] 1 => array:2 [ "nombre" => "J." "apellidos" => "Betancourt" ] 2 => array:2 [ "nombre" => "M." "apellidos" => "Benedetti Sandner" ] 3 => array:2 [ "nombre" => "K.A." "apellidos" => "Vázquez-Romo" ] 4 => array:2 [ "nombre" => "I." "apellidos" => "Hernández-Ayuso" ] 5 => array:2 [ "nombre" => "N." "apellidos" => "Ramos-Betancourt" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0365669118302326" "doi" => "10.1016/j.oftal.2018.06.022" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0365669118302326?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173579418301543?idApp=UINPBA00004N" "url" => "/21735794/0000009400000002/v1_201902010639/S2173579418301543/v1_201902010639/en/main.assets" ] "en" => array:20 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Short communication</span>" "titulo" => "Retinal manifestations in patients with complement-mediated membranoproliferative glomerulonephritis" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "95" "paginaFinal" => "99" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "L. de-Pablo-Gómez-de-Liaño, I. Cañas Zamarra, J.I. Fernández-Vigo, M. Fernández Vidal, C. Navarro-Perea, T. Cavero Escribano" "autores" => array:6 [ 0 => array:4 [ "nombre" => "L." "apellidos" => "de-Pablo-Gómez-de-Liaño" "email" => array:1 [ 0 => "depablo.lucia@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "I." "apellidos" => "Cañas Zamarra" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "J.I." "apellidos" => "Fernández-Vigo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "M." "apellidos" => "Fernández Vidal" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 4 => array:3 [ "nombre" => "C." "apellidos" => "Navarro-Perea" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 5 => array:3 [ "nombre" => "T." "apellidos" => "Cavero Escribano" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Departamento de Oftalmología, Hospital Universitario 12 de Octubre, Madrid, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Departamento de Oftalmología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria San Carlos (IdISSC), Madrid, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Departamento de Nefrología, Hospital Universitario 12 de Octubre, Madrid, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "<span class="elsevierStyleItalic">Corresponding author</span>." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Manifestaciones retinianas en pacientes con glomerulonefritis membranoproliferativa mediada por complemento" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 456 "Ancho" => 905 "Tamanyo" => 40508 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Retinography showing drusenoid deposits in posterior pole and exteriorly to the vascular arcades in both eyes.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">The eye is an organ that can be used as a window to diagnose various systemic diseases such as a specific type of glomerulonephritis, the membranoproliferative type (MPGN). This is an infrequent disease that debuts in association with proteinuria, hematuria, arterial hypertension and kidney failure in some cases (up to 50% at age 10).<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> MPGN arises due to progressive glomerular damage caused by the deposit of immune complexes, complement factors or both.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Classically the disease was divided in 3 types depending on the location of deposits under electronic microscope: subendothelial in type I, intramembrane in type II and subendothelial and subepithelial in type III. However, at present MPGN is classified on the basis of its etiology according to immunofluorescence as immune-mediated MPGN (most frequent) when a majority of immunoglobulin deposits are observed, or complement-mediated or glomerulopathy C3 if a predominantly C3 deposit is found at the glomerular level.<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">2–4</span></a> Glomerulopathy C3 comprises 2 diseases differentiated by morphology and location of deposits under electronic microscope. Accordingly, glomerulonephritis C3 features subendothelial and/or subepithelial deposits (formerly MPGN types I and III) and dense deposit disease when deposits are found intramembrane (formerly MPGN type II). Several studies have described the association of MPGN type II or dense deposits disease with the presence of drusenoid deposits at the retinal level, as well as the presence of choroidal neovascularization (CNV) and central serous choroidopathy.<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">5,6</span></a> However, very few studies have assessed the presence of retinal alterations on the basis of the 2 MPGN subtypes of the new classification, mediated by immune complexes and complement. One of said studies, of recent publication, concludes that complement-mediated MPGN gives rise to retinopathy with greater frequency when compared to immune complex-mediated MPGN, in which this association is rare.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">It has also been observed that the drusenoid deposits that appear in the retina of patients with MPGN are similar to those expressing at the subepithelial level in the glomerulus<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a> because their physiopathology is the same, i.e. hyperactivation of the alternative complement cascade pathway, with the retina and glomerulus being vulnerable to damage by C3 deposits.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">It is important for ophthalmologists to be aware of said pathology and the modern classification thereof because complement-mediated MPGN patients could exhibit retinal alterations requiring ophthalmological examinations and an adequate differential diagnostic. This is precisely the purpose of the present study.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Material and methods</span><p id="par0025" class="elsevierStylePara elsevierViewall">A transversal observational study of a case series comprising all patients in follow-up for complement-mediated MPGN at the Nephrology Dept. of the authors’ hospital. Patients signed an informed consent and the study complied with the Helsinki Declaration standards.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Historical patient data comprised age, sex, age at nephropathy diagnostic and evolution time thereof. In addition, an ophthalmological examination was performed comprising visual acuity (VA), funduscopy and spectral domain optical coherence tomography (OCT) exploring the macular area (Spectralis<span class="elsevierStyleSup">®</span>, Heidelberg Engineering, Germany) having a resolution of 4<span class="elsevierStyleHsp" style=""></span>μm and a scan rate of 40,000/s.</p><p id="par0035" class="elsevierStylePara elsevierViewall">When spectral OCT alteration was observed, a Swept Source domain OCT was also used (Triton<span class="elsevierStyleSup">®</span>, Topcon, Tokyo, Japan) as it features higher tissue penetration in order to evaluate the existence of choroidal changes. Said device has a resolution of 2.6<span class="elsevierStyleHsp" style=""></span>μm and a rate of 100,000<span class="elsevierStyleHsp" style=""></span>A scans/s applying the following modes: linear, with a 16<span class="elsevierStyleHsp" style=""></span>mm scanner, and angio-OCT (A-OCT) with 12<span class="elsevierStyleHsp" style=""></span>mm<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>12<span class="elsevierStyleHsp" style=""></span>mm protocol for an enhanced characterization of the lesions and to discard the presence of choroidal neovascularization.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Results</span><p id="par0040" class="elsevierStylePara elsevierViewall">Overall, 8 out of 15 patients diagnosed with complement-mediated MPGN in follow-up at the authors’ hospital were examined. It was impossible to make contact with 4 of the remaining 7 while 2 declined participation and the remaining patient had passed away. Mean age was 49.9<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>19.4 years (range 21–82), with predominance of females (5/8). Mean agea at MPGN diagnostic was 30.4<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>23.2 years (range: 12–72), with an evolution time at examination of 19.4<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>15.5 years (range 2–41). Right eye VA was, 93<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.11 (range 0.7–1) and left eye VA was 0.94<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.07 (range: 0.8–1). Two subjects required kidney transplant. Seven subjects of the group (87.5%) exhibited normal funduscopic examination and OCT while one patient exhibited MPGN-related changes.</p><p id="par0045" class="elsevierStylePara elsevierViewall">Said patient was a 42 year-old Caucasian with a history of hypothyroidism and tobacco smoking. Baseline clinic comprised proteinuria (0.53<span class="elsevierStyleHsp" style=""></span>g/day) and microhematuria, and the complement-mediated MPGN diagnostic was concluded after kidney biopsy in 2014. A genetic and immunological study was negative. Treatment was initiated with corticoids and mycophenolate.</p><p id="par0050" class="elsevierStylePara elsevierViewall">Ophthalmological examination was asymptomaticc with VA of 1 in both eyes, while funduscopy and retinography revealed the presence of diffuse drusen-like deposits in posterior pole and externally to the arcades (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>) appearing like RPE elevation in spectral OCT (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall">Superficial and deep retinal plexus and choriocapillary were evaluated with A-OCT, discarding the presence of vascular membranes associated to pigment epithelium detachment (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>).</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Discussion</span><p id="par0060" class="elsevierStylePara elsevierViewall">The present study analyzed 8 patients diagnosed with complement-mediated MPGN, one of which exhibited drusenoid deposits. In this case the lesions did not compromise VA despite a 4-year evolution of the kidney disease.</p><p id="par0065" class="elsevierStylePara elsevierViewall">Macular changes in MPGN can range from small drusenoid deposits in patients preserving excellent VA<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">3,4</span></a> to the development of large pigment epithelium detachments, retinal atrophy, CNV and central serous choroidopathy that could involve the appearance of scotoma and central vision distorsion.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1,5–7</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">The above described patient had been erroneously diagnosed with age-related macular degeneration (AMD) in a routine ophthalmological checkup. This was because both pathologies exhibit small diffuse yellowish lesions that generally compromise the posterior pole and have a similar composition.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a> The differential characteristics between both entities are that in MPGN drusenoid lesions emerge at earlier ages and in larger quantity and covering a larger retinal extension than in AMD. In addition, according to the study by Savige et al., complications compromising vision appear earlier and more frequently. Accordingly, said authors recommend discarding renal disease in patients under 50 years and could exhibit the presence of AMD.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">It has been described that the presence of drusen is more frequent in the complement-mediated MPGN type<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">2,4</span></a> as observed in 39% of cases (9/23) of the series by Dalvin et al., where 5 patients exhibited VA loss due to associated complications.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> Said study reported that, in a series of patients with immune complex-mediated MPGN, only 9% (2/23) of cases exhibited drusen, without associated visual alterations. The severity of ocular compromise is not always correlated to the severity of the kidney disease. However, when the renal disease is more evolved, ophthalmological compromise risk is higher.<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">3,5,9</span></a> Kheir et al. have described that various treatments utilized for nephropathy such as corticoids, immunosuppresants and/or plasmapheresis failed to improve the retinal disease.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">Accordingly and as proposed by other authors<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">2,5,10</span></a> it would be interesting to evaluate complement-mediated MPGN patient referrals in order to carry out the retinal examination at diagnostic, following up patients with large drusen so as to detect possible complications. In contrast, Dalvin et al., maintain this would not be necessary in the case of immune complex-mediated MPGN because the association between this pathology and eye fundus alterations is very small and the risk of diminished VA is lower.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> In turn, McAvoy et al. indicate that, considering the rarity of ocular complications, routine screening of patients with MPGN type II would not be necessary as only 1 exhibited diminished VA (due to CNV).<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">In addition, it is important to point out the possible usefulness of A-OCT in this disease to discard associated CNV without requiring the injection of contrast which in these patients could worsen pre-existing kidney damage, although this complication was not observed in the present series.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a></p><p id="par0090" class="elsevierStylePara elsevierViewall">Limitations of the present study include being its transversal nature without follow-up of patients affected by retinal alterations. Accordingly, studies with larger amount of patients and follow-up would be necessary to achieve a better characterization of this disease and its ocular complications.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Conclusions</span><p id="par0095" class="elsevierStylePara elsevierViewall">MPGN can give rise to retinal alterations with drusen or pigment epithelium detachment, for which reason it is necessary to perform an adequate differential diagnostic with AMD, with follow-up for these patients due to the possibility of complications which could cause loss of vision.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conflict of interests</span><p id="par0100" class="elsevierStylePara elsevierViewall">No conflict of interests was declared by the authors.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:11 [ 0 => array:3 [ "identificador" => "xres1144245" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1074797" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1144246" "titulo" => "Resumen" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0010" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1074796" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Material and methods" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Conclusions" ] 9 => array:2 [ "identificador" => "sec0030" "titulo" => "Conflict of interests" ] 10 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2018-04-20" "fechaAceptado" => "2018-06-19" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1074797" "palabras" => array:4 [ 0 => "Membranoproliferative glomerulonephritis" 1 => "Drusen-like deposits" 2 => "Retinal pigment epithelium detachment" 3 => "Optical coherence tomography" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1074796" "palabras" => array:4 [ 0 => "Glomerulonefritis membranoproliferativa" 1 => "Depósitos drusenoides" 2 => "Desprendimiento del epitelio pigmentario" 3 => "Tomografía de coherencia óptica" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Complement-mediated membranoproliferative glomerulonephritis is a rare progressive glomerular disease. In some patients it can be associated with retinal lesions. Therefore, the purpose of this study was to assess a case series with this diagnosis in our hospital. A cross-sectional study was conducted on 8 patients diagnosed with complement-mediated membranoproliferative glomerulonephritis. Funduscopy, optical coherence tomography (OCT) and Swept Source domain OCT angiography were performed. Only 1 of the 8 patients showed drusen-like deposits that were located under the retinal pigment epithelium in the OCT, with the presence of associated choroidal neovascularization being ruled out in OCT angiography. Therefore, membranoproliferative glomerulonephritis may produce retinal alterations with drusen or retinal pigment epithelium detachment, and requires an appropriate differential diagnosis to be made with age-related macular degeneration. The follow-up of these patients is important in order to detect vision-threatening complications.</p></span>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">La glomerulonefritis membranoproliferativa mediada por complemento es una enfermedad rara, pero puede asociarse a alteraciones retinianas. Por ello, el propósito de este estudio fue valorar una serie de casos con dicho diagnóstico en seguimiento por nefrología en nuestro centro. Se realizó un estudio transversal de 8 pacientes diagnosticados de glomerulonefritis membranoproliferativa mediada por complemento. Se realizó funduscopia, tomografía de coherencia óptica (OCT) y angio-OCT de dominio <span class="elsevierStyleItalic">Swept Source</span>. Uno de los 8 pacientes presentaba depósitos drusenoides que se localizaron bajo el epitelio pigmentario retiniano en la OCT, descartándose la presencia de neovascularización coroidea asociada en la angio-OCT. Por tanto, la glomerulonefritis membranoproliferativa puede producir alteraciones retinianas con drusas o desprendimientos del epitelio pigmentario retiniano, por lo que debe hacerse un adecuado diagnóstico diferencial con la degeneración macular asociada a la edad. Es crucial realizar un seguimiento en estos pacientes ante las posibles complicaciones que pueden desembocar en una pérdida de visión.</p></span>" ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: de-Pablo-Gómez-de-Liaño L, Cañas Zamarra I, Fernández-Vigo JI, Fernández Vidal M, Navarro-Perea C, Cavero Escribano T. Manifestaciones retinianas en pacientes con glomerulonefritis membranoproliferativa mediada por complemento. Arch Soc Esp Oftalmol. 2019;94:95–99.</p>" ] ] "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 456 "Ancho" => 905 "Tamanyo" => 40508 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Retinography showing drusenoid deposits in posterior pole and exteriorly to the vascular arcades in both eyes.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 698 "Ancho" => 1255 "Tamanyo" => 167682 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Spectral domain optical coherence tomography showing drusenoid deposits below the retina pigment epithelium.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Fig. 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 943 "Ancho" => 1255 "Tamanyo" => 157202 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Swept Source domain optical coherence tomography, with the location of these deposits being shown in higher resolution between the retina pigment epithelium and Bruch's membrane. Bottom: angio-OCT images that discarded the presence of CNV.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0055" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Retinal disease in the C3 glomerulopathies and the risk of impaired vision" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J. Savige" 1 => "L. Amos" 2 => "F. Lerino" 3 => "H.G. Mack" 4 => "R.C. Symons" 5 => "P. Hughes" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3109/13816810.2015.1101777" "Revista" => array:6 [ "tituloSerie" => "Ophthalmic Genet" "fecha" => "2016" "volumen" => "37" "paginaInicial" => "369" "paginaFinal" => "376" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26915021" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0060" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Manifestations of complement-mediated and immune complex-mediated membranoproliferative glomerulonephritis: a comparative consecutive series" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "L.A. Dalvin" 1 => "F.C. Fervenza" 2 => "S. Sethi" 3 => "J.S. Pulido" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ophtha.2016.02.018" "Revista" => array:6 [ "tituloSerie" => "Ophthalmology" "fecha" => "2016" "volumen" => "123" "paginaInicial" => "1588" "paginaFinal" => "1594" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26996341" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0065" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Multimodal imaging of retinal pigment epithelial detachments in patients with C3 glomerulopathy: case report and review of the literature" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "V. Kheir" 1 => "A. Dirani" 2 => "M. Halfon" 3 => "J.P. Venetz" 4 => "G. Halabi" 5 => "Y. Guex-Crosier" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1186/s12886-017-0602-4" "Revista" => array:5 [ "tituloSerie" => "BMC Ophthalmol" "fecha" => "2017" "volumen" => "17" "paginaInicial" => "207" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29166869" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0070" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Retinal findings in membranoproliferative glomerulonephritis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A.M. Mansour" 1 => "L.H. Lima" 2 => "J.F. Arevalo" 3 => "M.H. Amaro" 4 => "V. Lozano" 5 => "A.B. Ghannam" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Am J Ophthalmol Case Rep" "fecha" => "2017" "volumen" => "7" "paginaInicial" => "83" "paginaFinal" => "90" ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0075" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Retinal changes associated with type 2 glomerulonephritis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "C.E. McAvoy" 1 => "G. Silvestri" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Eye (Lond)" "fecha" => "2005" "volumen" => "19" "paginaInicial" => "985" "paginaFinal" => "989" ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0080" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Membranoproliferative glomerulonephritis type II associated with central serous retinopathy" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M.R. Ulbig" 1 => "P. Riordan-Eva" 2 => "F.G. Holz" 3 => "H.C. Rees" 4 => "P.A. Hamilton" 5 => "M.R. Ulbig" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Am J Ophthalmol" "fecha" => "1993" "volumen" => "116" "paginaInicial" => "410" "paginaFinal" => "413" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8213970" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0085" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Fundus changes in type III membranoproliferative glomerulonephritis: a case report" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Takei" 1 => "A. Obana" 2 => "T. Inomata" 3 => "T. Tanaka" 4 => "T. Shiang" 5 => "Y. Bae" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1186/s12886-018-0738-x" "Revista" => array:5 [ "tituloSerie" => "BMC Ophthalmol" "fecha" => "2018" "volumen" => "18" "paginaInicial" => "72" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29510686" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0090" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Structure and composition of drusen associated with glomerulonephritis: implications for the role of complement activation in drusen biogenesis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "R.F. Mullins" 1 => "N. Aptsiauri" 2 => "G.S. Hageman" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Eye (Lond)" "fecha" => "2001" "volumen" => "15" "paginaInicial" => "390" "paginaFinal" => "395" ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0095" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Sequential observation of fundus changes in patients withlong standing membranoproliferative glomerulonephritis type II (MPGN type II)" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "A. Leys" 1 => "Y. Vanrenterghem" 2 => "B. van Damme" 3 => "B. Snyers" 4 => "Y. Pirson" 5 => "M. Leys" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Eur J Ophthalmol" "fecha" => "1991" "volumen" => "1" "paginaInicial" => "17" "paginaFinal" => "22" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1821193" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0100" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Posterior segment changes in membranoproliferative glomerulonephritis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "D.D. Kim" 1 => "W.F. Mieler" 2 => "M.D. Wolf" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Am J Ophthalmol" "fecha" => "1992" "volumen" => "114" "paginaInicial" => "593" "paginaFinal" => "599" ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21735794/0000009400000002/v1_201902010639/S217357941830166X/v1_201902010639/en/main.assets" "Apartado" => array:4 [ "identificador" => "5812" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Short communications" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21735794/0000009400000002/v1_201902010639/S217357941830166X/v1_201902010639/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S217357941830166X?idApp=UINPBA00004N" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2023 March | 1 | 0 | 1 |
| 2020 September | 0 | 1 | 1 |
