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.

引言：
IgA肾病（IgA nephropathy，又称Berger病）是一类以IgA免疫复合物系膜沉积为特征的原发性肾小球肾炎。该病多以镜下或肉眼血尿为首发表现，但以眼部体征为初始临床表现的情况较为罕见。恶性高血压作为肾实质性疾病的严重并发症，可引发威胁视力的眼部病变，包括视盘水肿、黄斑水肿及高血压性脉络膜病变。因此，早期识别此类眼部表现，对于排查潜在的全身系统性疾病具有关键作用。

病例报告：
一名19岁女性患者，因双眼视力下降、右眼肿胀伴结膜下出血就诊，病程达2个月。眼科检查显示双侧视盘水肿、黄斑水肿，右眼可见多发点片状及火焰状出血、广泛软性渗出，以及颞侧脉络膜脱离，符合高血压性视网膜病变及脉络膜病变的临床特征。全身评估提示患者存在重度高血压（200/130 mmHg），实验室检查结果显示蛋白尿、镜下血尿及血清肌酐水平升高。肾活检（renal biopsy）证实为IgA肾病，伴系膜区IgA沉积。随后患者接受了降压及免疫抑制治疗。随访期间，右眼出现黄斑星芒状改变，视力较前改善。

结论：
本病例报告展示了一例以恶性高血压继发眼部表现为首发症状的罕见原发性IgA肾病。眼底检查（fundus examination）作为关键诊断线索，帮助临床早期明确了肾脏疾病的诊断。及时开展多学科诊疗对于预防不可逆视力丧失及全身并发症至关重要。