Drusen-like deposits in systemic disorders: A point of convergence for nephrologists and ophthalmologists
Department of Retina and Vitreous Services, Aravind Eye Hospital, Madurai, Tamil Nadu, India
Department of Retina and Vitreous Services, Aravind Eye Hospital, Madurai, Tamil Nadu
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Sen S. Drusen-like deposits in systemic disorders: A point of convergence for nephrologists and ophthalmologists.J Postgrad Med 2021;67:6-6
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Sen S. Drusen-like deposits in systemic disorders: A point of convergence for nephrologists and ophthalmologists. J Postgrad Med [serial online] 2021 [cited 2021 Oct 25 ];67:6-6
Available from: https://www.jpgmonline.com/text.asp?2021/67/1/6/309005
Drusen-like deposits (DLDs) have been described in multiple systemic diseases like membranoproliferative glomerulonephritis (MPGN) (dense deposit disease, C3 glomerulonephritis), including MPGN secondary to systemic lupus erythematosus (SLE), chronic inflammatory conditions like hepatitis B and C, and immunoglobulinemias. Drusenoid deposits have also been reported in Alport syndrome, vitamin A deficiency, pseudoxanthoma elasticum, Sjogren-Larsson syndrome, Kjellin syndrome, and familial partial lipodystrophy. DLDs in MPGN may develop at an earlier age than age-related macular degeneration (AMD), often in the second decade of life. Although DLDs may not directly cause visual impairment, vision may be affected by macular detachment, central serous chorioretinopathy, or choroidal neovascularizati?on similar to patients with AMD. Histologically, DLDs have been demonstrated to react with antibodies against C5, TIMP3, vitronectin, and amyloid P component, which are all hallmarks of AMD-associated drusen. One study on SLE patients with or without nephropathy found that DLDs were detected in 40% of all SLE patients, with glomerulonephritis patients having more DLDs per eye, larger deposits, and DLDs in more than three quadrants. Inflammation seems to be a common component in all these conditions, and complement alteration may be the primary cause of all these lesions.
In this issue of the journal, Handa et al have documented DLDs in a patient of multiple myeloma presenting with nephropathy, as a part of its inflammatory manifestations in the eye. Similar to drusen, the morphology and location of DLD can be accurately documented by optical coherence tomography (OCT), and they may be distinguished from drusen based on autofluorescence imaging, where unlike drusen, DLDs do not show hyper-autofluorescence. It can be inferred that any patient below the age of 50 demonstrating retinal drusen should be screened for renal disease at presentation and may be offered regular eye examinations. Moreover, a screening OCT may be performed in all patients presenting with glomerulonephritis, to detect the presence of drusen-like deposits.
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