Ocular features in Alport syndrome: pathogenesis and clinical significance

Clin J Am Soc Nephrol. 2015 Apr 7;10(4):703-9. doi: 10.2215/CJN.10581014. Epub 2015 Feb 3.


Alport syndrome is an inherited disease characterized by progressive renal failure, hearing loss, and ocular abnormalities. Mutations in the COL4A5 (X-linked), or COL4A3 and COL4A4 (autosomal recessive) genes result in absence of the collagen IV α3α4α5 network from the basement membranes of the cornea, lens capsule, and retina and are associated with corneal opacities, anterior lenticonus, fleck retinopathy, and temporal retinal thinning. Typically, these features do not affect vision or, in the case of lenticonus, are correctable. In contrast, the rarer ophthalmic complications of posterior polymorphous corneal dystrophy, giant macular hole, and maculopathy all produce visual loss. Many of the ocular features of Alport syndrome are common, easily recognizable, and thus, helpful diagnostically, and in identifying the likelihood of early-onset renal failure. Lenticonus and central fleck retinopathy strongly suggest the diagnosis of Alport syndrome and are associated with renal failure before the age of 30 years, in males with X-linked disease. Sometimes, ophthalmic features suggest the mode of inheritance. A peripheral retinopathy in the mother of a male with hematuria suggests X-linked inheritance, and central retinopathy or lenticonus in a female means that recessive disease is likely. Ocular examination, retinal photography, and optical coherence tomography are widely available, safe, fast, inexpensive, and acceptable to patients. Ocular examination is particularly helpful in the diagnosis of Alport syndrome when genetic testing is not readily available or the results are inconclusive. It also detects complications, such as macular hole, for which new treatments are emerging.

Keywords: Alport syndrome; extracellular matrix; genetic renal disease.

Publication types

  • Review

MeSH terms

  • Animals
  • Autoantigens / genetics
  • Collagen Type IV / genetics
  • Diagnostic Techniques, Ophthalmological
  • Eye Diseases / diagnosis
  • Eye Diseases / etiology*
  • Eye Diseases / genetics
  • Eye Diseases / therapy
  • Female
  • Genetic Predisposition to Disease
  • Humans
  • Male
  • Mutation
  • Nephritis, Hereditary / complications*
  • Nephritis, Hereditary / diagnosis
  • Nephritis, Hereditary / genetics
  • Nephritis, Hereditary / therapy
  • Phenotype
  • Predictive Value of Tests
  • Prognosis
  • Risk Factors


  • Autoantigens
  • COL4A4 protein, human
  • COL4A5 protein, human
  • Collagen Type IV
  • type IV collagen alpha3 chain