Retinal and choroidal thickness in paediatric patients with hypoalbuminaemia caused by nephrotic syndrome

Abstract

BackgroundA study was conducted to evaluate the choroidal thickness (CT) and retinal thickness (RT) in paediatric patients with hypoalbuminaemia caused by nephrotic syndrome (NS). We also studied the correlation between the subfoveal choroidal thickness (SFCT) and serum protein concentration.MethodsThis was a cross-sectional study. Fifty-one paediatric patients with hypoalbuminaemia caused by NS and 41 normal subjects were included in the study. Enhanced depth imaging optical coherence tomography (EDI-OCT) was performed to measure the RT and CT. The RT and CT were measured manually at intervals of 0.5 mm along a horizontal line through the macular fovea between 2.5 mm nasal and 2.5 mm temporal to the fovea. Clinical data including measurements of serum proteins were obtained.ResultsThe mean RTs at the T2.5, T2, N1.5, N2, and N2.5 locations and the average macular horizontal RT were slightly greater in the NS group than those in the control group. The mean CTs at all locations were significantly greater in the NS group than those in the control group; the difference was most significant at the fovea (373.8 ± 74.9 μm vs. 280.2 ± 57.1; p < 0.001). The SFCT in patients with NS was correlated with age (r = − 0.307, p = 0.003), body height (r = − 0.320, p = 0.022), body weight (r = − 0.343, p = 0.014), axial length (AL, r = − 0.237, p = 0.023), total protein (TP, r = − 0.302, p = 0.031), albumin (ALB, r = − 0.285, p = 0.042), prealbumin (PA, r = − 0.303, p = 0.033) and 24-h urine volume (UV, r = − 0.298, p = 0.034). Multiple linear regression analysis showed that the TP concentration and body weight had the highest correlation with the SFCT (R2 = 0.220, p < 0.05).ConclusionsThe macular RT is slightly increased and the macular CT is significantly increased in paediatric patients with hypoalbuminaemia caused by NS, indicating fluid accumulation in the retina and choroid. There is a negative correlation between the SFCT and serum TP concentration. Thus, the serum TP concentration is an important indicator of CT in patients with hypoalbuminaemia.

Evaluation of Visual Acuity, Macular Thickness, and Level of Proteinuria in Children with Nephrotic Syndrome

“…In contrast to our findings, Zhang et al [ 13 ] reported slightly different data. They observed a significantly thicker macular layer in children with nephrotic syndrome and hypoalbuminemia.…”

“…In contrast to our findings, Zhang et al reported slightly different data. They observed a significantly thicker macular layer in children with nephrotic syndrome and hypoalbuminemia [13]. Zhang et al therefore presumed that the above phenomenon could be related to the retention of liquid in the retina and choroid due to hypoproteinemia.…”

“…Recent studies have reported that children with nephrotic syndrome had a slight increase in macular thickness and reduction in retinal vessels density [ 13 , 14 ]. This has been attributed to the hypoalbuminemia induced fluid retention seen in this syndrome.…”

Progressive chorioretinal involvement in a patient with light-chain (AL) amyloidosis: a case report

“…These alterations would lead to secondary retinal pigment epithelium (RPE) dysfunction accounting for subretinal detachments and impaired photoreceptor outer segment phagocytosis leading to hyperautofluorescent subretinal material accumulation. The nephrotic syndrome could also have a role in the choroidal changes and subretinal detachments through a modification of the oncotic pressure [12,[17][18][19]. By restoring the plasmatic protein balance and decreasing amyloid deposits, the initiation of the first chemotherapy cycles led to the healing of the nephrotic syndrome and the resorption of the subretinal fluid.…”

Morphometrical analysis of the canine choroid in relation to age and sex using spectral domain optical coherence tomography

“…Diseases that decrease plasma protein can result in reductions in oncotic pressure that cause increased choroidal thickness as a consequence of increased retina and choroid water retention. For instance, choroidal thickness was greater in paediatric patients with nephrotic syndrome than in controls (Zhang et al, 2019). Oncotic pressure reductions can also result in more serious conditions such as bilateral retinoschisis or macular oedema (De Benedetto et al, 2012).…”