Bilateral retinal detachment - when the kidney meets the eye / Descolamento de retina bilateral - quando o rim afeta o olho

ABSTRACT Exudative retinal detachment occurs when fluid accumulates between the neurosensory retina and the retinal pigment epithelium. Ocular diseases or multisystem conditions such as nephrotic syndrome may lead to exudative retinal detachment. This report describes a case of nephrotic syndrome secondary to minimal change disease, anasarca and bilateral serous macular detachment in an adult patient. A 75-year-old male patient presented to the emergency department with generalized edema, asthenia, and visual impairment. Medical history included a recent diagnosis of nephrotic syndrome secondary to minimal change disease, which had been controlled with corticosteroid therapy. At presentation, best corrected visual acuity was 20/100. Slit-lamp examination revealed xanthelasmas and mild bilateral eyelid edema and chemosis. Dilated fundus examination confirmed bilateral macular detachment. The patient did not respond to diuretic therapy. Ttherefore, hemodialysis was started. Two months later, visual acuity improved to 20/25 and near normal restoration of retinal anatomy was achieved, with concurrent remission of proteinuria. Exudative retinal detachment is a multifactorial condition. However, in diseases associated with severe hypoalbuminemia, such as nephrotic syndrome, low oncotic pressure in choroidal vessels and high interstitial pressure in the choroid may explain retinal detachment. Patients with chronic kidney disease carry a high risk of ophthalmic disease development. Several mechanisms that affect ocular vessels, the retina and the choroid are thought to be involved. A multidisciplinary approach is crucial to resolve the ophthalmic condition and improve overall health.

RESUMO O descolamento de retina exsudativo ocorre quando o fluido se acumula entre a retina neurossensorial e o epitélio pigmentado da retina. Patologias oculares isoladas ou doenças multissistêmicas, como a síndrome nefrótica, podem levar ao descolamento de retina exsudativo. Apresenta-se aqui o caso de um adulto com síndrome nefrótica por doença de lesões mínimas, anasarca e descolamento de retina exsudativo macular bilateral. Trata-se de um homem de 75 anos de idade, que recorreu ao serviço de urgência com edema generalizado, astenia e diminuição da acuidade visual. Os antecedentes pessoais incluíam diagnóstico recente de síndrome nefrótica secundária à doença de lesões mínimas, em uso de corticoterapia. Na apresentação, a melhor acuidade visual corrigida era 20/100. A biomicroscopia revelou xantelasmas, edema palpebral leve e quemose nos dois olhos. Fundoscopia mostrou descolamento macular bilateral. O doente iniciou diuréticos com pouca resposta clínica, tendo sido adicionada hemodiálise. Verificou-se melhora da acuidade visual para 20/25 e restauração quase total da anatomia da retina 2 meses após o início do tratamento, coincidindo com a remissão da proteinúria. A fisiopatologia dos descolamentos de retina exsudativos é multifatorial, mas, em doenças com hipoalbuminemia grave, como a síndrome nefrótica, a baixa pressão oncótica e a alta pressão intersticial na coroide podem explicar o descolamento macular exsudativo. Doentes com doença renal crônica constituem um grupo de risco para o desenvolvimento de doença ocular, envolvendo vários mecanismos que afetam vasos, retina e coroide. Uma abordagem multidisciplinar é crucial para a melhoria da doença oftalmológica e do estado geral do doente.

Alterações histopatológicas e macroscópicas em um cão sorologicamente positivo para Leptospira spp / Case report: Macroscopic and histopathological changes in a dog serologically positive for Leptospira spp

A leptospirose é uma zoonose de distribuição mundial com elevada incidência em regiões tropicais.Nos cães ela se apresenta com grande polimorfismo clínico e estes animais são consideradosfonte de infecção da leptospirose humana, mesmo quando não apresentam qualquer sinal clínicocaracterístico. O processo de patogênese é caracterizado pelo desenvolvimento de vasculite, lesãoendotelial e infiltrado inflamatório composto por células monocíticas, plasmócitos, histiócitos eneutrófilos. O objetivo deste estudo foi relatar o caso de um cão sorologicamente positivo paraleptospirose. Logo após o óbito, o animal foi encaminhado ao Departamento de Patologia Animaldo Hospital Veterinário da Universidade Federal de Uberlândia. Na necropsia foram diagnosticadasicterícia hemolítica e nefrite intersticial crônica moderada. As alterações macroscópicas, histológicase sorológicas do animal foram sugestivas de doença hemolítica grave compatível com leptospirose.

Leptospirosis is a zoonosis of worldwide distribution with high incidence in tropical regions.Leptospirosis in dogs presents with large clinical polymorphism and these animals are consideredsources of infection for human leptospirosis, even without showing any clinical signs. Pathogenesisis characterized by the development of vasculitis, endothelial injury and infiltration of monocyticcells, plasma cells, histiocytes and neutrophils. The objective of this study was to report the caseof a dog serologically positive for leptospirosis. The animal died and then was submitted to theAnimal Pathology Department of the Veterinary Hospital of the Federal University of Uberlândia At necropsy hemolytic jaundice and moderate chronic interstitial nephritis were diagnosed. Themacroscopic, histological and serological changes suggest severe hemolytic disease consistent withleptospirosis.

Factors related to transmission of and infection with Schistosoma mansoni in a village in the South-eastern Region of Brazil

In this transversal study, factors related to infection with and transmission of Schistosoma mansoni were explored. Based on stool examinations of two Kato-Katz smears of a single sample, the prevalences of schistosomiasis and geohelminths were established. In a multivariable analysis, sets of demographic, socio-economic and water contact pattern variables were tested for strength of relation with infection. Males presented a 3.39-times higher risk for infection than females. The age groups between 10-19 years and 20-30 years showed risks of infection 7.1- and 7.5-times higher, respectively, than the control age group between 0-10 years. Individuals practicing leisure activities had a 1.96-times higher risk than those without these activities. The malacological survey identified snails of the species Biomphalaria glabrata, Biomphalaria straminea and Biomphalaria tenagophila. Two exemplars of B. glabrata (0.53 percent) proved positive for S. mansoni. The socio-economic improvements observed in the locality suggest a protective and preventive effect towards infection with schistosomiasis, which requires further investigation with a longitudinal and more detailed study design. Considering our findings, a proposal for an integrated control program should be based on two pillars: one horizontal, which involves social empowerment and health education, and another more vertical, which delivers treatment and infrastructure improvements.