Azotemic retinitis

Description:

The azotemic retinitis reflects changes of an eyeground at arterial hypertension. Due to the big prevalence of an idiopathic hypertensia (23% of unselected world's population) it is necessary to expect that also the frequency of the pathology of an eyeground connected with this disease increases.

Symptoms of the Azotemic retinitis:

Classification Keitha-Wagner.

Stage of I. Small narrowing of arterioles or angiosclerosis. The general good shape, hypertensia is not present.

Stage of II. More expressed narrowing of arterioles, arteriovenous decussations. There is no retinopathy. Hypertensia. The general good shape, functions of heart and kidneys are not broken.

Stage of III. An angiospastic retinopathy (wadded focuses, hemorrhages, swelled retinas). High hypertensia. Dysfunction of heart and kidneys.

Stage of IV. Papilloedema (swelled an optic nerve) and considerable vasoconstriction. The state menacing.
Clinic

Allocate 2 forms of changes of an eyeground: eyeground pathology without retinopathy and an azotemic retinitis.

At the first form retinal arteries and arterioles have more rectilinear course, numerous arteriovenous decussations are observed. The wall of an artery is condensed, presses on the subject vein, causing narrowing of a gleam of a vein in the place of decussation. In certain cases, especially at a combination to an involutional sclerosis, arterioles become sharply narrowed, pale - a symptom of "a silver wire", crimpiness and a phlebectasia - Gvist's symptom appear. On the developing hypertensia specifies stagnation in a vein distalny arteriovenous decussation. Sooner or later vascular changes of a retina are complicated by a retinopathy with the advent of hemorrhages and exudate. Hemorrhages often arise in the field of a makula and come from surrounding precapillary arterioles.

Some hemorrhages are located on the course of nerve fibrils and have an appearance of strips. On veins the cases representing deposits of white exudate can be formed.

At acute hypertensia at persons with high diastolic pressure as a result of occlusion of arterioles of a retina the true heart attack of a retina looking as cotton wool lumps (hlopkovidny exudate) develops. Neovascularization of a retina and optic nerve can be observed.

At malignant hypertensia on an eyeground, except a retinopathy, develops swelled an optic nerve. In a macular zone there can be deposits of solid exudate in the form of a star figure.

Reasons of the Azotemic retinitis:

Changes of arterioles of an eyeground at an idiopathic hypertensia repeat defeats of arterioles of other bodies, in particular a brain. The main type of defeat of an eyeground is considered миелоэластофиброз, the hyalinosis which expressiveness depends on duration of an idiopathic hypertensia and weight of hypertensia is more rare.

Treatment of the Azotemic retinitis:

Treatment comes down to treatment of an idiopathic hypertensia.