Bivas Bala1, Viswanath Pratap2, Soumi Kanji3
BACKGROUND
In diabetes mellitus microvascular damages at various end-organ frequently
occurs and leads to development of diabetic nephropathy as well as diabetic
retinopathy. Diabetic nephropathy ultimately causes end stage renal disease.
Diabetic retinopathy even at its earlier stage is easily suspected by simple clinical
examination in any ophthalmological clinic. We wanted to study the relationship
between various stages of diabetic retinopathy with diabetic nephropathy.
METHODS
1209 diagnosed patients of diabetic mellitus were screened for presence of
diabetic retinopathy. First comprehensive ophthalmological examination including
slit-lamp bimicroscopy and indirect ophthalmoscopy were done and then clinically
typing of diabetic retinopathy according to ETDRS classification was done. Then
all diagnosed case of diabetic retinopathy further examined for blood Glycosylated
haemoglobin, blood urea and serum creatinine to detect diabetic nephropathy.
RESULTS
273 patients were included in this study. Average age of patients was 64.6 years
with mean duration of diabetes mellitus was 7.4 years. Patients suffering from
severe NPDR and PDR had association with poor control of blood glycosylated
haemoglobin. Patients with mild NPDR 31.1 %, Moderate NPDR 52.3 %, severe
NPDR 67.4 % and in PDR 65.2 % patient had blood urea more than 40 mg / dl.
In mild NPDR group 32.2 %, moderate NPDR 55.4 %, severe NPDR 67.4 % and
in PDR group 63.9 % patients had serum creatinine more than 1.5 mg / dl. We
have found statistically significant correlation between HbA1c level and severity of
diabetic retinopathy. Prevalence of nephropathy increased with increments in the
grade of retinopathy.
CONCLUSIONS
A significant number of patients with severe NPDR or PDR had increased blood
urea and serum creatinine level. Clinical grading of diabetic retinopathy gives us a
clue about the presence of diabetic nephropathy. As diagnosis of diabetic
retinopathy is simple and straight forward clinical procedure and it can be done all
ophthalmological se up, we recommend all patient with diabetic retinopathy must
be screened for nephropathy.
