title: Vision-threatening retinal abnormalities in chronic kidney disease stages 3 to 5.
abstract: OBJECTIVE
  Retinal abnormalities are common in inherited and acquired renal disease. This study determined the prevalence of retinal abnormalities in chronic kidney disease (CKD) stages 3 to 5.
  
  
  METHODS
  One hundred fifty patients with CKD stages 3 to 5 and 150 age- and gender-matched hospital patients with CKD stages 1 to 2 underwent bilateral retinal photography. These images were reviewed for incidental abnormalities, microvascular (Wong and Mitchell classification) and diabetic retinopathy (Airlie House criteria), and macular degeneration (Seddon classification).
  
  
  RESULTS
  Three (2%) patients with CKD stages 3 to 5 had retinal features characteristic of inherited renal disease (atrophy in Myopathy, Encephalopathy, Lactic Acidosis, Stroke-like episodes [MELAS] syndrome; and 2 with drusen in dense deposit disease). Fifty-nine (39%) patients had moderate-severe microvascular retinopathy (hemorrhages, exudates, etc.) compared with 19 (13%) with CKD stages 1 to 2. Forty-one (28%) had moderate-severe diabetic retinopathy (microaneurysms, exudates, etc.) compared with 16 (11%) with CKD stages 1 to 2. Ten (7%) had severe macular degeneration (geographic atrophy, hemorrhage, exudates, membranes) compared with one (1%) with CKD stages 1 to 2. Renal failure was an independent risk factor for microvascular retinopathy, diabetic retinopathy, and macular degeneration. Eleven (7.3%) patients with renal failure and one (0.7%) with CKD stages 1 to 2 had previously unrecognized vision-threatening retinal abnormalities that required immediate ophthalmologic attention.
  
  
  CONCLUSIONS
  Retinal abnormalities are common in CKD stages 3 to 5, and are more severe and more likely to threaten vision than in hospital patients with CKD stages 1 to 2.
authors.affiliation: The University of Melbourne, Department of Medicine, Northern Health, Cooper Street, Melbourne, Victoria 3076 Australia.
authors.forename: Rajeev
authors.initials: R
authors.lastname: Deva
authors.forename: Mohamad Afzal
authors.initials: MA
authors.lastname: Alias
authors.forename: Deb
authors.initials: D
authors.lastname: Colville
authors.forename: Foong Kien Newk-Fon Hey
authors.initials: FK
authors.lastname: Tow
authors.forename: Qi Lun
authors.initials: QL
authors.lastname: Ooi
authors.forename: Sky
authors.initials: S
authors.lastname: Chew
authors.forename: Nor
authors.initials: N
authors.lastname: Mohamad
authors.forename: Anastasia
authors.initials: A
authors.lastname: Hutchinson
authors.forename: Ignatios
authors.initials: I
authors.lastname: Koukouras
authors.forename: David A
authors.initials: DA
authors.lastname: Power
authors.forename: Judith
authors.initials: J
authors.lastname: Savige
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000554:Ambulatory Care Facilities; D016009:Chi-Square Distribution; D002908:Chronic Disease; D003430:Cross-Sectional Studies; D003930:Diabetic Retinopathy / Q000453:epidemiology; D003941:Diagnostic Techniques, Ophthalmological; D005260:Female; D006801:Humans; D007297:Inpatients; D007674:Kidney Diseases / Q000175:diagnosis / Q000453:epidemiology*; D016015:Logistic Models; D008268:Macular Degeneration / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D015995:Prevalence; D011379:Prognosis; D012164:Retinal Diseases / Q000175:diagnosis / Q000453:epidemiology*; D012166:Retinal Hemorrhage / Q000453:epidemiology; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D014739:Victoria / Q000453:epidemiology; D014786:Vision Disorders / Q000175:diagnosis / Q000453:epidemiology*; D055815:Young Adult