Abstract
Background: Retinopathy and renal involvement are two of the major microvascular complications of diabetes mellitus. Recent reports challenge the traditional view of renal involvement progressing from increased glomerular filtation to progressively increasing levels of albuminuria that culminate in chronic kidney disease, and have found that retinopathy and albuminuria may not always co-exist. This study was undertaken to understand the relationship between retinopathy, albuminuria and chronic kidney disease in patients with type 2 diabetes mellitus.
Methods: One hundred patients with type 2 diabetes mellitus attending the diabetic clinic were evaluated for retinopathy and renal parameters that included a 24 urinary albumin excretion, serum creatinine and evidence of chronic kidney disease based on the estimated glomerular filtration rate.
Results: 67 patients were found to have retinopathy, out of which 12 (17.9 %) had no evidence of any abnormal renal parameters, 25 (37.3%) had only abnormal albuminuria (microalbuminuria or macralbuminuria), one (1.5 %) had evidence of CKD, and 29 (43.3 %) had both albuminuria and CKD. 16 patients with CKD did not have any evidence of retinopathy.
Conclusion: There was a statistically significant association between the presence and severity of retinopathy, and abnormal urinary excretion of albumin. A similar association between retinopathy and CKD was not seen.
Keywords: Diabetic retinopathy, Microalbuminuria, Macroalbuminuria, Normoalbuminuria, Chronic kidney disease, Estimated glomerular filtration rate.
References
- Anjana RM, Deepa M, Pradeepa R, Mahanta J, Narain K, Das HK, et al. Prevalence of diabetes and prediabetes in 15 states of India: results from the ICMR-INDIAB population-based cross-sectional study. Lancet Diabetes Endocrinol. 2017;5:585–96.
- Gerstein HC, Ambrosius WT, Danis R, Ismail-Beigi F, Cushman W, Calles J, et al. Diabetic Retinopathy, Its Progression, and Incident Cardiovascular Events in the ACCORD Trial. Diabetes Care. 2013;36:1266–71.
- Yau JWY, Rogers SL, Kawasaki R, Lamoureux EL, Kowalski JW, Bek T, et al. Global Prevalence and Major Risk Factors of Diabetic Retinopathy. Diabetes Care. 2012;35:556–64.
- Pugliese G. Updating the natural history of diabetic nephropathy. Acta Diabetol. 2014;51:905–15.
- Kramer HJ, Nguyen QD, Curhan G, Hsu C-Y. Renal insufficiency in the absence of albuminuria and retinopathy among adults with type 2 diabetes mellitus. JAMA. 2003;289:3273–7.
- Retnakaran R, Cull CA, Thorne KI, Adler AI, Holman RR. Risk Factors for Renal Dysfunction in Type 2 Diabetes. Diabetes. 2006;55:1832–9.
- Parving H-H, Persson F, Rossing P. Microalbuminuria: a parameter that has changed diabetes care. Diabetes Res Clin Pract. 2015;107:1–8.
- Reutens AT. Epidemiology of diabetic kidney disease. Med Clin North Am. 2013;97:1–18.
- Boronat M, García-Cantón C, Quevedo V, Lorenzo DL, López-Ríos L, Batista F, et al. Non-albuminuric renal disease among subjects with advanced stages of chronic kidney failure related to type 2 diabetes mellitus. Ren Fail. 2014;36:166–70.
- Sabanayagam C, Foo VHX, Ikram MK, Huang H, Lim SC, Lamoureux EL, et al. Is chronic kidney disease associated with diabetic retinopathy in Asian adults? J Diabetes. 2014;6:556–63.
- Inker LA, Levey AS. Pro: Estimating GFR using the chronic kidney disease epidemiology collaboration (CKD-EPI) 2009 creatinine equation: the time for change is now. Nephrol Dial Transplant. 2013 Jun 1;28:1390–6.
- Sharma A, Sharma R, Ankur, Paul J, Tyagi A, Khari S, et al. A Study of Microalbuminuria Levels among Patients with Type 2 Diabetic Complications in Western U.P. Int J Contemp Med. 2017;5:84.
- Rani PK, Raman R, Gupta A, Pal SS, Kulothungan V, Sharma T. Albuminuria and Diabetic Retinopathy in Type 2 Diabetes Mellitus Sankara Nethralaya Diabetic Retinopathy Epidemiology And Molecular Genetic Study (SN-DREAMS, report 12). Diabetol Metab Syndr. 2011 May 25;3:9.
- Manaviat MR, Afkhami M, Shoja MR. Retinopathy and microalbuminuria in type II diabetic patients. BMC Ophthalmol. 2004;4:9.
- Karoli R, Fatima J, Shukla V, Garg P, Ali A. Predictors of diabetic retinopathy in patients with type 2 diabetes who have normoalbuminuria. Ann Med Health Sci Res. 2013;3:536–40.
- Lampropoulou I-T, Stangou M, Papagianni A, Didangelos T, Iliadis F, Efstratiadis G. TNF-α and microalbuminuria in patients with type 2 diabetes mellitus. J Diabetes Res. 2014; 7
- Penno G, Solini A, Zoppini G, Orsi E, Zerbini G, Trevisan R, et al. Rate and Determinants of Association Between Advanced Retinopathy and Chronic Kidney Disease in Patients With Type 2 Diabetes. Diabetes Care. 2012;35:2317–23.
- Gall M-A, Hougaard P, Borch-Johnsen K, Parving H-H. Risk factors for development of incipient and overt diabetic nephropathy in patients with non-insulin dependent diabetes mellitus: prospective, observational study. BMJ. 1997 Mar 15;314:783.
- Moriya T, Tanaka S, Kawasaki R, Ohashi Y, Akanuma Y, Yamada N, et al. Diabetic Retinopathy and microalbuminuria can predict macroalbuminuria and renal function decline in Japanese type 2 diabetic patients. Diabetes Care. 2013;36:2803–9.
- MacLennan PA, McGwin G, Heckemeyer C, Lolley VR, Hullett S, Saaddine J, et al. Eye Care Use Among a High-Risk Diabetic Population Seen in a Public Hospital’s Clinics. JAMA Ophthalmol. 2014;132:162–7.
Corresponding Author
Dr Annapurna Kumar
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DOI: https://dx.doi.org/10.18535/jmscr/v6i1.145
