A 29-year-old woman diagnosed with CRF secondary to FSGS.
She was admitted for hemodialysis at age 25.
Three years after hemodialysis, the patient presented severe secondary hyperparathyroidism (SHPT) with PTH i >1,000 pg/ml, with bone pain, asthenia, pruritus and persistent symptomatic hypotension.
There are no arterial or echocardiographic findings.
Parathyroid ultrasound was performed without visualization and spike with 99Tc and MIBI with diffuse increase of the fixation of the left and right inferior parathyroid lobe.
He treats his SHPT with calcium chelating agents and dyspareunia with iv calcitrio due to hyperphosphatemia.
Subtotal parathyroidectomy is indicated considering the patient's age and his/her aptitude for transplantation.
The results of the previous laboratory tests were: hematocrit 37%, Hb 12.1, Ca 9 mg/dl, P 6 mg/dl, K 5 meq/l.
Coagulogram was normal.
Parathyroid biopsy: bilateral hyperplasia.
During surgery he was hypotensive (TApromean 90/60).
Six days after surgery she presented partial loss of vision in the RE and total loss of the LE, moderate hypo-Ca and symptomatic hypotension.
Laboratory: hematocrit 36%, Hb 12, Ca 6.3 Ca i 0.72l, P 3.5, Mg 1.9.
Hypo-Ca values were corrected.
The collagenogram and coagulogram were normal, and anticardiolipin, lupus anticoagulant, pANCA and c and serology for toxoplasmosis and syphilis were negative.
He consulted with neurology: he had right nasal hemianopsia and left eye bullet vision.
Pathological diagnosis: VA with vision counts of 50 cm in the left eye and moderate vision in the right eye.
Areactive mydriasis in OI, reactive in OD.
Eye fundus: applied retina, normal macula and congestive papilla with incipient oedema (OI and D).
PO 10/10 mmHg.
MRI of brain and normal bulb.
Visual evoked potentials in RE and LE of medium amplitude and prolonged central latencies compatible with moderate optic pathway involvement, compatible with optic neuropathy.
Visual acuity: 0.5 in left eye, 0.8 in right eye.
Campimetry: outside normal limits for the RE with alteration of relative sensitivity and restriction of blind spot (increased).
In OI there is a total reduction in sensitivity.
Corticosteroids (prednisone) were prescribed at a dose of 1 mg/kg/day for 30 days.
Elevated papillary oedema in both eyes and clinically with bullous vision in RE and amaurosis of the left eye.
At the bottom of the eye two months after surgery, almost all the right optic nerve was detected with dilation and venous tortuosity and total of the left optic nerve.
