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Hypertensive retinopathic changes can be particularly severe in renal failure and have been ascribed to the effects of retained nitrogen products. Accelerated hypertension can result in optic disc oedema. Alternatively, patients treated with maintenance haemodialysis may experience hypotension, a common side effect of ultrafiltration. The ability to easily visualize the arteries and veins of the retina often indicates the condition of small ADAMTS12 blood vessels throughout the body, a time-honoured way of monitoring blood pressure and assessing the efficacy of antihypertensive therapy. Also, in the issue of the Clinical Kidney Journal, Bansal and colleagues report two cases of dialysed patients who suffered severe longstanding hypotension with bilateral non-arteritic anterior ischaemic optic neuropathy (NA AION) [5]. NA-AION is an acute ischaemic disorder of the optic nerve head with an incidence rate of ?2�C10 per 100 000 [6]. Hypotension is one of the most commonly encountered complications of haemodialysis, with a rapid decrease in blood volume which occurs during ultrafiltration. NA-AION occurring as a result of haemodialysis is rare and Bansal provides a review of the literature, which includes fewer than 20 episodes since its initial report in 1986. Both patients in this report had bilateral, painless vision loss and benefited from Smad inhibitor blood pressure stabilization, which resulted in visual acuity improvement, with a residual visual field defect in one patient. Management strategies for NA-AION in dialysis patients have not been well established and in most cases measures are taken to raise the patient's blood pressure, although neuroprotection studies involving N-methyl-d-aspartate Alpelisib solubility dmso receptor antagonists in animal models are currently under way [7]. These two articles demonstrate the importance of recognizing ocular symptoms in patients as a marker of systemic disease and identifying significant visual changes in those patients already known to have nephrotic proteinuria undergoing treatment. A comprehensive eye examination should be carried out in patients with chronic or end-stage kidney disease as was demonstrated by the CRIC study group [8]. They examined retinal photographs of 1936 individuals with varying stages of kidney disease and found that 45% had pathologies that required ophthalmologic follow-up, while 3% had serious eye lesions that required urgent treatment. This group determined further associations from this cohort, including the fact that an estimated glomerular filtration rate (GFR)