背景:缺血性视神经病变(ION)在接受透析的儿童中极为罕见,由于视神经灌注不良,表现为突然的急性无痛性视力丧失。
方法:我们报告了一例3岁男性患者,因慢性血液透析双侧肾切除术后出现局灶性节段性肾小球硬化(FSGS)状态,患有5期慢性肾病(CKD5),在血液透析治疗后几小时出现急性视力丧失。那天早些时候,他在透析中血压下降到89/67mmHg,家庭血压范围为90/60至150/100mmHg。患者接受了严格的血压控制治疗,以维持血液流动并防止血压不稳定,接受了皮质类固醇锥度的大剂量皮质类固醇,并给予大剂量促红细胞生成素以发挥神经保护作用。他在演示后大约1个月恢复部分视力。
结论:我们的患者的同时双侧前后离子的确切原因,通过MRI和胃镜检查证实,不清楚;然而,可能是继发于血压波动的组合,贫血,焦虑状态,和血液透析。这凸显了密切血压监测的必要性,贫血的管理,对慢性血液透析的儿科患者进行更勤奋的眼科筛查。
BACKGROUND: Ischemic optic neuropathy (ION) is exceedingly rare in children on dialysis, resulting from poor perfusion of the optic nerve, and presents as sudden acute painless vision loss.
METHODS: We report the case of a 3-year-old male with stage 5 chronic kidney disease (CKD 5) due to focal segmental glomerulosclerosis (FSGS) status post-bilateral nephrectomy on chronic hemodialysis who had acute loss of vision several hours after a hemodialysis session. Earlier that day, he had a drop in blood pressure intra-dialysis to 89/67 mmHg, with at home blood pressures ranging 90/60 to 150/100 mmHg. The patient was treated with tight blood pressure control to maintain blood flow and prevent blood pressure lability, received high-dose corticosteroids with a corticosteroid taper, and placed on high-dose erythropoietin for neuroprotective effect. He regained partial vision beginning approximately 1 month after presentation.
CONCLUSIONS: The exact cause of our patient\'s simultaneous bilateral anterior and posterior ION, confirmed via MRI and fundoscopic examination, is unclear; however, is likely secondary to a combination of fluctuating blood pressure, anemia, anephric status, and hemodialysis. This highlights the need for close blood pressure monitoring, management of anemia, and more diligent ophthalmologic screening in pediatric patients on chronic hemodialysis.