Type 2 Diabetes Kidney Damage And Diabetic Retinopathy Clinical And Pathological Study

BackgroundThe underlying mechanism of diabetic kidney disease (DKD) and diabetic retinopathy (DR) remains unclear, but the hypothesis that persistent hyperglycemia and its abnormal metabolites play a vital role has never been ruled out. Based on this theory, it may be postulated that DKD and DR begin at the same time of disease course. Some reports say it is just the case, however, a remarkable discordance has been found between DKD and DR, especially in type 2 diabetic patients. Moreover, there has been little evidence in Chinese patients. Therefore, the present study will investigate the possible relationship between DR and DKD in Chinese type 2 diabetic patients.ObjectiveTo evaluate the potential relationship between diabetic kidney injuries and diabetic retinopathy in Chinese patients with type 2 diabetes , from the prospective of clinical findings as well as pathological results.MethodsPart 1: We retrospectively analyzed 201 patients for whom a diagnosis of type 2 diabetes had been confirmed and had been hospitalized in the endocrine department in our hospital in the year of 2007. Part 2: 142 consecutive type 2 diabetic patients with persistent macroalbuminuria(> 300mg/24h), an ophthalmoscopy and an adequate renal biopsy were enrolled. The biopsy were evaluated by 2 masked nephrologists.Results(1) Patients with albuminuria were much more often complicated with DR than those without, while patients with macroalbuminuia were much more often complicated with PDR than those with microalbuminuria and normoalbuminuria. Patients with DR and without DR had significant differences in diabetes duration, insulin use, prevalence of DKD, eGFR, SCr concentration and SBP, among which albuminuria and duration of diabetes are independent predictors for diabetic retinopathy, while macroalbuminuria and duration of diabetes are independent predictors for proliferative diabetic retinopathy (PDR). (2) For the 29 patients with typical diabetic glomerulopathy (DG), 79. 3% (23/29) were complicated with DR, much more higher than patients in ADRD and NDRD group(p<0. 01). All 11 patients with PDR revealed typical DG. The negative predictive value of DR for DG is 94.9%, and a positive predictive value of PDR for DG is 100. 0%. (3) All patients in DG and ADRD groups had positive staining of VEGF antibody. 15 patients in DG group and 10 patients in ADRD group appeared to have stronger staining than control patients. For those patients in DG group who had stronger VEGF antibody staining than control patients, a higher prevalence of PDR was found.Conclusion1. Albuminuria and DR are strongly associated. We intend to believe that DR and DKD begins at the same time of disease course or one after another. For those with albuminuria, a close monitoring of the fundus is recommended, the vice versa. 2. For type 2 diabetic patients with macroalbuminuria, DR has a strong relation with DG.. For macroalbuminuric patients without DR, a renal biopsy should be performed if possible.