Posterior ischemic optic neuropathy following continuous renal replacement therapy: a case report
Dublin Core
Title
Posterior ischemic optic neuropathy following continuous renal replacement therapy: a case report
Subject
Continuous renal replacement therapy, Posterior ischemic optic neuropathy, Visual loss
Description
Abstract
Background Posterior ischemic optic neuropathy (PION) is a rare cause of acute vision loss in intensive care unit
patients. PION following continuous renal replacement therapy (CRRT) hemodialysis has not ever been reported.
Here, we report a case of bilateral nonarteritic PION following the initiation of CRRT.
Case presentation A 52-year-old man with hypertension and stage 4 chronic kidney disease was admitted due to
metabolic acidosis, hyperkalemia, and acute exacerbation of CKD. CRRT caused transient hypotension upon initiation
but corrected the metabolic acidosis and hyperkalemia six hours after initiation. Therefore, CRRT was stopped.
However, several hours after the cessation of CRRT, the patient experienced sudden, painless vision loss in both eyes.
Assessment of his visual acuity revealed the inability to perceive light in both eyes. There were no symptoms or signs
of giant cell arteritis. An ophthalmological examination revealed no abnormalities. Magnetic resonance imaging of
the brain revealed no compressive lesions or acute stroke, but magnetic resonance angiography revealed stenosis of
both the bilateral carotid artery and the right middle cerebral artery. Administration of a high dose of corticosteroids
did not reverse his vision loss. Thus, nonarteritic PION following CRRT was diagnosed.
Conclusions PION should be considered if a patient with multiple vascular risk factors complains of sudden painless
vision loss without signs of optic disk edema after the initiation of CRRT. Preventing blood pressure drops during the
initiation of CRRT in patients with multiple vascular risk factors may prevent PION.
Keywords Continuous renal replacement therapy, Posterior ischemic optic neuropathy, Visual loss
Background Posterior ischemic optic neuropathy (PION) is a rare cause of acute vision loss in intensive care unit
patients. PION following continuous renal replacement therapy (CRRT) hemodialysis has not ever been reported.
Here, we report a case of bilateral nonarteritic PION following the initiation of CRRT.
Case presentation A 52-year-old man with hypertension and stage 4 chronic kidney disease was admitted due to
metabolic acidosis, hyperkalemia, and acute exacerbation of CKD. CRRT caused transient hypotension upon initiation
but corrected the metabolic acidosis and hyperkalemia six hours after initiation. Therefore, CRRT was stopped.
However, several hours after the cessation of CRRT, the patient experienced sudden, painless vision loss in both eyes.
Assessment of his visual acuity revealed the inability to perceive light in both eyes. There were no symptoms or signs
of giant cell arteritis. An ophthalmological examination revealed no abnormalities. Magnetic resonance imaging of
the brain revealed no compressive lesions or acute stroke, but magnetic resonance angiography revealed stenosis of
both the bilateral carotid artery and the right middle cerebral artery. Administration of a high dose of corticosteroids
did not reverse his vision loss. Thus, nonarteritic PION following CRRT was diagnosed.
Conclusions PION should be considered if a patient with multiple vascular risk factors complains of sudden painless
vision loss without signs of optic disk edema after the initiation of CRRT. Preventing blood pressure drops during the
initiation of CRRT in patients with multiple vascular risk factors may prevent PION.
Keywords Continuous renal replacement therapy, Posterior ischemic optic neuropathy, Visual loss
Creator
Hiro Takefuji1* and Junpei Komagamine1
Source
https://doi.org/10.1186/s12245-025-00872-w
Date
2025
Contributor
Peri Irawan
Format
pdf
Language
english
Type
text
Files
Collection
Citation
Hiro Takefuji1* and Junpei Komagamine1, “Posterior ischemic optic neuropathy following continuous renal replacement therapy: a case report,” Repository Horizon University Indonesia, accessed April 11, 2026, https://repository.horizon.ac.id/items/show/12742.