Diabetic Nephropathy in Type 2 Diabetic Retinopathy Requiring Panretinal Photocoagulation

Abstract

PurposeTo investigate the risk factors of diabetic nephropathy in patients with diabetic retinopathy requiring panretinal photocoagulation (PRP) and the visual prognosis.MethodsA retrospective review of electronic medical records was conducted at Seoul St. Mary's Hospital, comprising 103 patients with type 2 diabetes mellitus and diabetic retinopathy who underwent PRP from 1996 to 2005. Patients with type 1 diabetes mellitus, non-diabetic renal disease, non-diabetic retinal disease, visually significant ocular disease, high-risk proliferative diabetic retinopathy, and advanced diabetic retinopathy were excluded. The patients were divided into three groups: no nephropathy (group 1, n = 45), microalbuminuria (group 2, n = 16), and advanced nephropathy (group 3, n = 42). Duration of diagnosis of retinopathy and nephropathy, glycosylated hemoglobin, visual acuity, complications, and treatment history were investigated.ResultsThe mean glycosylated hemoglobin of group 3 (8.4 ± 1.2) was higher than that of group 1 (7.7 ± 1.0) or group 2 (7.7 ± 1.0) (p = 0.04). Mean interval from PRP to diagnosis of nephropathy was 8.8 ± 6.0 years in group 2 and 8.7 ± 4.9 years in group 3. The significant decrease in visual acuity in group 3 (28 eyes, 35.9%) was significantly higher than that in group 1 (15 eyes, 18.1%, p = 0.01) or group 2 (6 eyes, 20.7%, p = 0.03). Only vitreous hemorrhage showed a significantly higher incidence in groups 2 and 3 than in group 1 (p = 0.02). Multivariate regression analysis revealed that female sex and lower glycosylated hemoglobin were significantly associated with a protective effect on development of nephropathy.ConclusionsIn the clinical setting, many patients with PRP-requiring diabetic retinopathy develop nephropathy an average of 8 to 9 years after PRP. Male sex and higher glycosylated hemoglobin could be risk factors of nephropathy.

miR‐218 regulates diabetic nephropathy via targeting IKK‐β and modulating NK‐κB‐mediated inflammation

“…Previous work has found that multiple distinct miRNAs can modulate the progression of DN via targeting a wide range of signaling pathways relating to autophagy, oxidative and mechanical stress, and advanced glycation end-product generation (Chung, 2015;Nascimento & Domingueti, 2019). A range of interrelated factors including genetics, ischemia, inflammation, and hypoxia have all been found to contribute to DN progression (Ha, Choi, Kim, Na, & Park, 2019;Xu, Natarajan, & Chen, 2019 (Barutta et al, 2013;Huang et al, 2014). In this study, we found that miR-218 also regulated inflammatory signaling in a Inflammation is a central regulatory process governing DN pathogenesis, with inflammatory factors including IL-1, IL-6, and TNF-α all being linked to the development of this disease (Yang et al, 2019).…”

Clinical Characteristics, Preventive Care and Attitude to Telemedicine among Patients with Diabetic Retinopathy: A Cross-Sectional Study

“…This observation is in line with other studies’ findings [ 1 , 7 , 10 ]. Such conduct is essential because prevention, early diagnosis, and effective treatment of many comorbidities, such as hypertension, hyperlipidemia, or heart disease, exert a significant impact on DR development and progression [ 9 , 12 , 16 , 27 ]. We found that 54% of DR patients suffer from hyperlipidemia, and 68% suffer from hypertension.…”

“…It emphasizes the importance of preventive screening of such comorbidities and regular monitoring of DR progression. Furthermore, DR is not the only complication of diabetes, as it also leads to various disorders such as chronic kidney disease, lower extremity ischemia, coronary heart disease, neuropathy, stroke, myocardial infarction, depression, and many others [ 1 , 3 , 7 , 8 , 9 , 10 , 11 , 28 , 29 ]. We found that DR patients significantly more often undergo several medical examinations to diagnose these life-limiting and life-threatening complications.…”

“…It is reasonable in DR patients to decrease glucose serum levels with antidiabetic drugs with very low capacity to provoke hypoglycemia, like GLP-1RA and SGLT-2 inhibitors. Moreover, hypo- and hyperglycemia are also relevant risk factors for many other diabetes-related complications [ 2 , 9 ]. A telemedical technology reminding about blood glucose measurement could reduce the fluctuations of serum glucose levels and improve treatment outcomes.…”

“…The pathophysiology involves several biochemical mechanisms, which lead to inflammation, local ischemia, vascular hyperpermeability, neuroglial and microvascular pathology, and loss of endogenous repair mechanisms [ 4 , 6 , 7 , 8 ]. The development of this complication is a complex, multifactorial process that is influenced by many indirect risk factors [ 3 , 6 , 7 , 8 , 9 , 10 , 11 ]. Hence, the development of DR is challenging to predict.…”