title: Early nephropathy predicts vision-threatening retinal disease in patients with type I diabetes mellitus.
abstract: In type I (insulin-dependent) diabetes mellitus, nephropathy may be identified in its early stages by the development of persistent microalbuminuria. This longitudinal study sought to examine the development of vision-threatening retinal disease (VTRD) (proliferative retinopathy and clinically significant macular edema) in such patients with early and evolving diabetic kidney disease. Eighty patients with type I diabetes and at least 8 yr of longitudinal data were identified. Glycated hemoglobin and albumin excretion rate (AER) were measured every 3 mo. Ophthalmologic examination was performed at least yearly. Thirteen patients were identified as having evolving nephropathy by a progressive increase in AER and the presence of microalbuminuria during the study period. Sixty-seven patients remained persistently normoalbuminuric. VTRD developed in eight of 13 (62%) patients with evolving nephropathy compared with five of 69 (7%) patients who were persistently normoalbuminuric (P < 0.001) in the absence of any difference in long-term glycemic control or duration of diabetes between the two groups. Clinically significant macular edema (P < 0.05) and proliferative retinopathy (P < 0.01) were both more common in patients with evolving nephropathy. In such patients, AER was 150 x/divided by 1.7 micrograms/min at the time of laser photocoagulation for VTRD. These data suggest that patients with type I diabetes and evolving nephropathy may be at higher risk of developing VTRD than patients who remain persistently normoalbuminuric despite similar long-term glycemic control and duration of diabetes.
authors.affiliation: Department of Medicine, Austin and Repatriation Medical Centre, Heidelberg, Victoria, Australia.
authors.forename: R E
authors.initials: RE
authors.lastname: Gilbert
authors.forename: C
authors.initials: C
authors.lastname: Tsalamandris
authors.forename: T J
authors.initials: TJ
authors.lastname: Allen
authors.forename: D
authors.initials: D
authors.lastname: Colville
authors.forename: G
authors.initials: G
authors.lastname: Jerums
mesh_terms: D000328:Adult; D003922:Diabetes Mellitus, Type 1 / Q000503:physiopathology*; D003928:Diabetic Nephropathies / Q000503:physiopathology*; D003930:Diabetic Retinopathy / Q000150:complications*; D005260:Female; D005544:Forecasting; D006801:Humans; D008297:Male; D014786:Vision Disorders / Q000209:etiology*