Spectral-Domain Optical Coherence Tomography for Determination of Retinal Thickness in Pediatric Patients with Mild-To-Moderate Chronic Kidney Disease: A Cross-Sectional Study

ABSTRACT

Objective: Children with chronic kidney diseases (CKD) are at risk for neurological diseases at early adulthood. Spectral-domain optical coherence tomography (SD-OCT) of the retina is especially suitable for determination of intraretinal layer thickness. We wonder whether retinal thinning is already present in pediatric patients with mild-to-moderate CKD.

Patients and Methods: Children (n = 15; 14.9 ± 2.4 years) with mild-to-moderate CKD (median eGFR of 95ml/min/1.73m²; range: 28–187ml/min/1.73m²) due to glomerulopathy, congenital anomalies of kidney and urinary tract (CAKUT), or haemolytic uremic syndrome (HUS) underwent a detailed ophthalmologic examination including high-resolution SD-OCT. Three OCT scans were obtained from the right eyes of all patients. Within each scan, retinal layers were separated and the mean thickness was determined at the foveal, parafoveal, and perifoveal area. The results were compared to those we obtained previously from healthy children.

Results: At the parafoveal area, thickness (median, range) of the total retina (ALL), ganglion cell layer (GCL), and inner plexiform layer (IPL) were reduced compared to healthy volunteers (339µm, (288–361µm) vs. 348µm, (320–385µm); 49.8µm (30.5–56.6µm) vs. 53.5μm (49.5–60.5µm) and 41.0µm (29.4–43.7µm) vs. 43.46µm (39.5–46.3μm); each p < 0.05). The intraretinal thickness measurements at the foveal and perifoveal areas revealed no statistically significant differences between patients and controls.

Conclusion: Distinct changes within the parafoveal area of the total retina, GCL, and IPL are present in children with mild-to-moderate CKD. Prospective studies are required to assess the clinical significance of our findings.

KEYWORDS:

• Children
• chronic kidney disease
• ganglion cell layer
• neural degeneration
• retinal neurodegeneration
• spectral-domain optical coherence tomography

Supplemental data

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Abbreviations

CAKUT	=	congenital anomalies of kidney and urinary tract;
CKD	=	chronic kidney disease;
CNS	=	central nervous system;
C	=	controls;
DR	=	diabetic retinopathy;
GCL	=	ganglion cell layer;
HUS	=	haemolytic uremic syndrome;
INL	=	inner nuclear layer;
IPL	=	inner plexiform layer;
ONL	=	outer nuclear layer;
OPL	=	outer plexiform layer;
PRL	=	photoreceptor layer;
RNFL	=	retinal nerve fiber layer;
RPE	=	retinal pigment epithelium;
SDS	=	standard deviation score;
SD-OCT	=	spectral-domain optical coherence tomography.

Acknowledgments

We thank all families, especially the children, who participated in this study and gratefully acknowledge the support of our colleagues.

Disclosure Statement

The authors report no potential conflicts of interest.

Financial Disclosure

No relevant financial relationships relevant to this article to disclose.

Additional information

Funding

German Research Foundation (project VIES)