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J. Garrett, J. Corbett, M. Santiago, H. Wafapoor; The Association of Idiopathic Intracranial Hypertension in Patients With Chronic Renal Failure . Invest. Ophthalmol. Vis. Sci. 2005;46(13):656.
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Purpose: Idiopathic intracranial hypertension (IIH) is a condition that is characterized by blurry vision, headache, papilledema, elevated CSF pressure, and normal MRI. IIH has been shown to be associated with hypervitaminosis A. Excessive vitamin A has been reported in the serum and CSF of patients with chronic renal failure. The purpose of this study is to determine if IIH is prevalent in this population. Methods: Patients with a diagnosis of chronic renal failure with either creatinine levels greater than 2.0 at the time of the exam or with a history of creatinine levels greater than 2.0 on two previous occasions were examined for papilledema. The screenings were performed at the VA Medical Center and the University of Mississippi Medical Center in 1999 and 2004. These patients were examined by dilated fundus exam or with direct ophthalmoscopy. Also included in the data are the age, sex, race, height, weight, BUN, creatinine, systemic diseases, dialysis status, systolic blood pressure, and diastolic blood pressure. Results:Fifty–one patients with chronic renal failure were screened for papilledema. Creatinine levels range from 1.8–19.9. Of the patients examined, 33% were female, and 69% were male. Age range was 26 to 87 years old. 11% were caucasian, and 89% were black. At the time of the exam, 84% also had hypertension, and 57% had diabetes mellitus. Of those examined, 63% were on dialysis. Systolic blood pressure ranged from 89–223 while diastolic blood pressure ranged from 52–116. Three patients were found to have papilledema (5.9% of the patients screened). Conclusions: The association of idiopathic intracranial hypertension in patients with chronic renal failure may be related to excessive vitamin A levels in these patients. The incidence of IIH in the general population of Mississippi is 1.8/100,000. The current incidence of renal failure in the United States is 333/1,000,000 and rising. As the number of patients with renal failure in Mississippi also continues to rise, the diagnosis of IIH should be considered for those patients who have symptoms compatible with that diagnosis.
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