Vision loss in a pregnant woman with nephrotic syndrome.

PURPOSE: To report acute visual acuity loss in a pregnant woman with nephrotic syndrome. CASE REPORT: A 34-year-old pregnant woman was referred to our service for acute, bilateral visual impairment, associated with bilateral below knee edema (BKE). Best-corrected visual acuity (BCVA) was hand motion in the right eye and 20/200 in the left eye. Dilated fundus exam disclosed multiple pigment epithelium detachments involving the macula in both eyes. After consultation with a nephrologist a diagnosis of nephrotic syndrome was made. Unfortunately, a week later she lost the fetus. At follow-up evaluation, 20 days after the miscarriage, BCVA improved to 20/25 in both eyes with near normal restoration of the retinal anatomy. CONCLUSION: In nephrotic syndrome, sequestration of interstitial fluids, which leads to classic generalized edema, could be the origin of interstitial accumulation of fluids in the retinal and subretinal layers. Increased awareness by the gynaecologists and prompt treatment may prevent fetus miscarriage.

Two-step minipercutaneous ureterolithotripsy under multimodal analgesia for complicated impacted calculi in proximal ureter.

OBJECTIVE: To suggest minipercutaneous ureterolithotripsy using the mininephroscope as an alternative process for impacted stones of the upper ureter because these stones can be challenging to treat and can produce severe symptoms. MATERIALS AND METHODS: We report our results of cases in which the percutaneous approach using 2-step minipercutaneous ureteroscopy with the mininephroscope was used to achieve relief from the stone, with minimal anesthesia risks. A total of 54 patients (33 men and 21 women) presented with impacted stones in the proximal ureter. The mean stone size was 16.2 mm (range 10-21). All patients were treated with 2-step minipercutaneous antegrade ureterolithotripsy under multimodal analgesia. RESULTS: The mean operative time was 49 minutes (range 40-110). Placement of the percutaneous drainage tube was quick and was performed with the patient under local anesthesia. The minipercutaneous session followed several days later, with the patient under multimodal anesthesia. The initial stone-free rate was 94%. The stone-free rate 2 months after the procedure was 100%. All procedures were well tolerated by the patients (group mean visual analog scale score 3.1 ± 0.7 standard deviation). No severe adverse events were noted. The mean hospital stay was 5.3 days (range 3-12). CONCLUSION: In selected emergency cases of impacted proximal ureteral stones, the approach of the initial insertion of a nephrostomy tube followed by a second session of antegrade ureterolithotripsy using the mininephroscope is a safe and effective alternative treatment, especially, because it can be accomplished with minimal anesthesia requirements.