The association between retinal ischaemia and end-stage renal damage in thrombotic microangiopathy

Haemolytic uraemic syndrome (HUS) and thrombotic thrombocytopenic purpura(TTP) are conditions in which thrombocytopenia and microangiopathichaemolytic anaemia are associated with organ damage due to thromboticmicroangiopathy (TMA). The prognosis for adults with HUS is variable, withsome patients presenting with an acute illness from which a full recoveryis made, whilst others develop irreversible renal failure. Evidence ofretinal ischaemia was noted on presentation in a normotensive patient withirreversible renal failure due to HUS. This study examined prospectivelythe optic fundi of all patients who subsequently presented to a singleadult renal unit (catchment population approximately 700,000) with HUS.Eleven patients presented with HUS over 12 years (1985-1997). Six patientswith irreversible renal failure had retinal abnormalities either at thetime or within a few days of initial presentation. The other five patientswhose renal function recovered did not develop retinal changes during thecourse of their illness. Retinal ischaemia associated with TMA is a poorprognostic sign in adults with HUS.