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Papillorenal syndrome: a systemic diagnosis not to be missed on funduscopy
  1. Benjamin Ng1,
  2. Samantha De Silva1,2 and
  3. Mandeep Bindra1
  1. 1Department of Ophthalmology, Stoke Mandeville Hospital, Aylesbury, UK
  2. 2Oxford Eye Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
  1. Correspondence to Dr Benjamin Ng; benjamin.ng1{at}nhs.net

Abstract

A 45-year-old man presented to the ophthalmology department with visual symptoms in his left eye. Almost two decades ago, he required a renal transplant for focal segmental glomerular sclerosis and a detailed enquiry revealed a strong family history of renal and ocular disease. Fundus examination demonstrated significant optic disc dysplasia in his left eye and optical coherence tomography showed intraretinal fluid bilaterally. The diagnosis of papillorenal syndrome was suspected and genetic testing identified a heterozygous pathogenic variant in the PAX2 gene c.76dupG, p.Val26Glyfs*28, confirming the diagnosis. The patient was treated conservatively, and his vision eventually improved and stabilised. His renal disease and transplant were concurrently monitored by nephrologists. In this case, history-taking and ophthalmic examination raised suspicion of this rare systemic condition, which led to genetic testing and molecular confirmation of the diagnosis. We therefore highlight this case to raise awareness of papillorenal syndrome, which has significant systemic implications and also impacts familial screening and genetic counselling.

  • retina
  • genetic screening / counselling
  • chronic renal failure
  • renal transplantation

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Footnotes

  • Contributors BN, SDS and MB contributed to the planning of this case report. BN obtained consent from the patient, and drafted the initial manuscript. SDS and MB provided relevant images, interpretation of investigations and critical revision to the manuscript. Our institute, Stoke Mandeville Hospital, is a part of Buckinghamshire Healthcare NHS Trust, the institute that is a Fellow or BMJ Case Reports.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer-reviewed.

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