Scleritis and Kidney Disease - More than meets the eye...

Scleritis is a severe inflammation involving the deep episclera and sclera. Symptoms include moderate to marked pain, hyperemia of the globe, lacrimation, and photophobia.

Scleritis tends to recur and is frequently associated with an underlying systemic illness, such as rheumatoid arthritis, lupus, IgA vasculitis, polyarteritis nodosa and granulomatosis with polyangiitis.   A few cases are infectious in origin and about half of the cases of scleritis have no known cause.

 In Renal Grand Rounds on Tuesday, Patrick McGlynn presented a case of 30 year-old healthy female who came to clinic complaining of pain and redness on her right eye. Blood pressure was elevated at 155/90 mmHg. On exam, right eye had redness on sclera. No involvement of left eye. No papilledema on fundoycopic exam. Ophthalmology was consulted and thought the exam was consistent with sectoral scleritis inferotemporally on right eye (representative figure above). Labs showed a creatinine of 1.79mg/dL and urine sediment analysis revealed few WBC casts. Based on acute presentation with renal failure and active urine sediment, a kidney biopsy was performed, revealing IgA nephropathy.

 Ocular involvement in patients with IgA nephropathy is infrequent, but may lead to uveitis, episcleritis, scleritis or retinal vasculitis. For sure worth keeping an eye…