Supplementary Material for: Ophthalmic Manifestations Heralding Renal Pathology: A Rare Case of Bilateral Optic Disc Edema with Exudative Maculopathy in IgA Nephropathy

Introduction:
IgA nephropathy (Berger’s disease) is a primary glomerulonephritis characterized by mesangial deposition of IgA immune complexes. While it commonly presents with microscopic or gross haematuria, ocular findings as the initial manifestation are rare. Malignant hypertension, a severe complication of renal parenchymal disease, can lead to vision-threatening ocular changes such as optic disc edema, macular edema, and hypertensive choroidopathy. Early ophthalmic recognition can therefore play a pivotal role in uncovering the underlying systemic disorder.

Case Presentation:
A 19-year-old female presented with diminution of vision of both eyes, swelling and subconjunctival haemorrhage of the right eye for a period of two months. Ophthalmic examination revealed bilateral optic disc edema, macular edema, multiple dot blot and flame shaped haemorrhages, widespread soft exudates and a temporal choroidal detachment in the right eye, suggestive of hypertensive retinopathy and choroidopathy. Systemic evaluation revealed severe hypertension (200/130 mmHg) and laboratory findings of proteinuria, microscopic hematuria, and elevated serum creatinine. Renal biopsy confirmed IgA nephropathy with mesangial IgA deposition. The patient was started on antihypertensive and immunosuppressive therapy. On follow-up, the right eye developed a macular star pattern with visual improvement.

Conclusion:
This case highlights a rare primary presentation of IgA nephropathy manifesting initially with ocular findings secondary to malignant hypertension. Fundus examination served as a critical diagnostic clue, leading to early identification of renal disease. Prompt multidisciplinary management is essential to prevent irreversible visual loss and systemic complications.