Letters to the Editor

Indian Pediatrics 2004; 41:406-407

Chronic Renal Failure with Retinal Detachment

We read with interest the article "Chronic Renal failure in Children" by Hari et al. They have dealt in detail on the etiology of chronic renal failure (CRF) from a large pool of cases attending their clinic. Since the authors have also covered on the issues of management we have a small query. Did they come across any case of CRF with visual problem or retinal detachment? Were they routinely doing opthalmological examination in their follow up cases? Recently, we came across a 15-year-old girl, who presented to ophthalmology department as bilateral loss of vision. On examining her eye she was found to have bilateral bullous retinal detachment. Her general physical examination revealed she had severe hypertension (above 99th centile for her age) and subsequently her investigation revealed as having CRF. When we reviewed the literature (Medline Search), we found that retinal detachments are a known complication of chronic renal failure, though majority of case reports and series are from adult patients. Numerous hypothesis have been suggested for retinal detachments-dilutional hypo-natremia(2), severe hypertension(3), ischemic infarction of choroids(4) and choroids spasm(5). Multiple factors may be operable simultaneously. The interesting part is that the retinal detachment is reversible when various causes or the complications are managed adequately and that includes renal trans-plantation as well. We feel that reversible retinal detachment occurring in association with renal insufficiency has not been emphasized sufficiently in pediatric literature. It would be worthwhile for patients with chronic renal disease to undergo a complete retinal examination including indirect opthalmoscopy routinely, so as to detect and treat this condition. It is probably not rare, but will be seen more frequently if looked for carefully.

Srikanta Basu,
Suksham Jain,
Department of Pediatrics,
Government Medical College,
Sector 32, Chandigarh, India.

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