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Renal insufficiency and diabetic retinopathy

Discussion in 'Ophthalmology: Eye Physicians & Surgeons' started by Richard_Hom, Apr 27, 2004.

  1. Richard_Hom

    Richard_Hom Senior Member
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    Dear Forum,

    1. What is the current thought regarding the relationship of renal insufficency and diabetic retinopathy?

    2. Does renal insufficiency precede or proceed diabetic retinopathy?

    3. Is there a correlation between renal insufficiency and the onset of diabetic macular edema?

    4. Can diabetic macular edema be detected even earlier with HRT macular module or OCT or RTA?

    Regards,
    Richard_Hom
    on a Jornada
     
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  3. Andrew_Doan

    Andrew_Doan Doc, Author, Entrepreneur
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    We don't have enough data about OCT to determine its specificity and sensitivity in detecting diabetic macular edema.

    In regards to your other questions, you should take a look at these papers:

    http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=12761421

    "On average retinopathy developed after 14+/-1.8 yrs. after the diabetes mellitus onset, neuropathy -17.8+/-2.2 yrs., renal failure - 21.1+/-2.8 yrs., heart failure - 22.9+/-1.9 yrs. and arterial hypertension - 12.1+/-1.3 yrs. "

    http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=12401751

    Concomitance of diabetic retinopathy and proteinuria accelerates the rate of decline of kidney function in type 2 diabetic patients.

    Trevisan R, Vedovato M, Mazzon C, Coracina A, Iori E, Tiengo A, Del Prato S.

    Unit for Metabolic Diseases, Department of Clinical and Experimental Medicine, University of Padova, Padova, Italy. [email protected]

    OBJECTIVE: To evaluate the rate of progression of renal disease in proteinuric type 2 diabetic patients with and without retinopathy. RESEARCH DESIGN AND METHODS: Thirty-eight proteinuric type 2 diabetic patients with diabetic retinopathy and 27 without were enrolled in an observational study for the evaluation of rate of glomerular filtration rate (GFR) decline and followed up for a median period of 6 years. GFR was determined at least once per year, and blood pressure, glycated hemoglobin, and proteinuria were determined every 4 months. RESULTS: Although the two groups had comparable GFR, albuminuria, blood pressure, and HbA(1c) at entry of the study, the rate of decline of GFR was higher in type 2 diabetic patients with retinopathy (-6.5 +/- 4.4 ml/year) than in those without (-1.8 +/- 4.8 ml/year; P < 0.0001). Protein and albumin excretion rate increased significantly in patients with retinopathy, while they did not change in those without. Mean blood pressure between the two groups of patients were similar both at entry and during the follow-up, although the proportion of patients treated with at least two antihypertensive drugs was higher in patients with retinopathy. On a multiple regression analysis, only mean blood pressure and proteinuria were significant determinants of progression of renal disease in type 2 diabetic patients with retinopathy. CONCLUSIONS: The rate of progression of renal disease in proteinuric type 2 diabetic patients with retinopathy is faster than that observed in those without retinopathy. The screening for retinopathy identifies patients at high risk for rapid deterioration of kidney function.
     
  4. jwolfe

    jwolfe Junior Member
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    I think this paper is also worth reviewing. Although not exactly what you were asking, still germane. Those with vision loss due to diabetic retinopathy at the early visits were all dead at this long term f/u. I realize this is f/u from only one of the trial sites and I am missing many of the details as it has been awhile since I read the paper and don't have access to it now. You will have to read the paper to get to the heart of it as it is difficult to get just from the abstract.
    I think that sometimes (mostly) we forget how deadly diabetes can be. This paper reveals that and can provide some evidence when counseling pts and physicians regarding control of blood sugar...

    http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=13129862

    Ophthalmology. 2003 Sep;110(9):1683-9.
    The long-term effects of laser photocoagulation treatment in patients with diabetic retinopathy: the early treatment diabetic retinopathy follow-up study.
     
  5. Richard_Hom

    Richard_Hom Senior Member
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    Dear Forum,

    1. Taking this one step, would essential hypertension be additive to diabetes in its effect in renal function?

    2. How about hyperlipidemia or dyslipidemia? Has either shown a predictive indicator for progression of degradation of renal function?

    Thanks,
    Richard_Hom
     
  6. Andrew_Doan

    Andrew_Doan Doc, Author, Entrepreneur
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