Microalbuminuria and Diabetic Retinopathy

Barnett, Anthony; Dallinger, K. J. C.; Jennings, P.E.; Fletcher, J.; Odugbesan, O.

doi:10.1016/s0140-6736(85)91008-6

Cited by 55 publications

(19 citation statements)

References 5 publications

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“…Therefore, the difference in psychophysical performance between the two diabetic groups raises the issue of whether visual function loss is the initial stage of the development of retinopathy. The evidence from this investigation and previous work indicates that screening programmes for retinopathy should be refined by including psychophyscial procedures and monitoring of early nephropathy (Barnet et al 1985). These results have provided encouragement for further studied incorporating computer controlled procedures and a double blind trial eliminate observer bias.…”

Section: Discussionmentioning

confidence: 54%

“…microalbuminuria, serve as a predictor of overt nephropathy (Viberti et al 1982;Mathieson et al 1984;Mogensen & Christensen 1984), and as an indicator of a higher mortality risk garret et al 1981;Mogensen 1984). It has also been suggested that microalbuminuria predicts proliferative retinopathy (Vigstrup & Mogensen 1985; Mogensen et al 1985), which justifies frequent ophthalmic examination (Barnet et al 1985).…”

Section: Psychophysical Measures Of Visual Functionmentioning

confidence: 99%

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Loss of visual function associated with microalbuminuria in diabetes mellitus

Dhanesha

Gilchrist

Miles

et al. 1991

Acta Ophthalmologica

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Visual function loss has been documented in diabetes mellitus in relation to flicker and contrast. However, no direct correlation between the degree of loss in sensitivity and the level of retinopathy has been established. It has been suggested that such non-invasive psychophysical procedures actually reflect metabolic disturbances within the diabetic retina. This study investigates the possibility of whether early nephropathy demonstrated by microalbuminuria, is an indicator of microangiopathy which may be a cause of retinal disturbance leading to a loss of visual function. The visual function of a group of diabetics showing microalbuminuria was studied. Contrast and flicker threshold were measured and the results compared with those obtained with an age-matched control diabetic group. The procedures used effectively separated the two groups and raises the issue of incorporating psychophysics in retinal screening programmes.

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Section: Discussionmentioning

confidence: 54%

Section: Psychophysical Measures Of Visual Functionmentioning

confidence: 99%

Loss of visual function associated with microalbuminuria in diabetes mellitus

Dhanesha

Gilchrist

Miles

et al. 1991

Acta Ophthalmologica

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“…Several recent studies [37][38][39] have demonstrated that the well known association between diabetic retinopathy and overt nephropathy extends to include incipient nephropathy as well. Because of the small number of patients in our study, the results cannot be directly compared with the results of larger series.…”

Section: Microalbuminuria In Young Sudanese Patients With Type 1 Diabmentioning

confidence: 99%

“…It has been shown that high blood pressure level accelerates, and effective blood pressure reduction slows down, the progression of diabetic renal disease [34,35]. Thus, the treatment of arterial blood pressure elevations at much lower levels than those attempted in the past has been recommended [36].Several recent studies [37][38][39] have demonstrated that the well known association between diabetic retinopathy and overt nephropathy extends to include incipient nephropathy as well. Because of the small number of patients in our study, the results cannot be directly compared with the results of larger series.…”

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confidence: 99%

Microalbuminuria in Young Sudanese Patients with Type 1 Diabetes

et al. 1993

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Overnight urinary albumin excretion (UAE) was measured in 51 patients, nine to 18 years old, with type 1 (insulindependent) diabetes mellitus and in 22 healthy subjects using radioimmunoassay. Thirteen diabetic patients (25.5%) had microalbuminuria defined as UAE rate between 20 and 200 (μg/min. Eleven of these patients were over 13 years of age. This gives a frequency of microalbuminuria of 42% (11/26) in the diabetic children and adolescents in the age group 14-18 years. UAE rate was positively correlated with both age at diagnosis and duration of diabetes. Arterial blood pressure, systolic and diastolic, glycosylated hemoglobin (HbA 1c ) and insulin dosage U.kg-1.day-1 were significantly higher (P<0.001) in the diabetic patients with microalbuminuria compared to the diabetic patients with normal UAE rate. Retinal changes were also more common in the microalbuminuric diabetic patients than in the diabetic patients without microalbuminuria (P<0.01). This study has revealed a high prevalence of microalbuminuria in young Sudanese patients with type 1 (insulin-dependent) diabetes mellitus and emphasized the importance of routine screening of diabetic children after the age of 12 years. Ann Saudi Med 1993;13(6) Despite the marked reduction in the incidence of diabetic nephropathy that occurred in recent decades, it is estimated that between 30% to 35% of the patients with type 1 (insulin-dependent) diabetes mellitus are still at risk of developing this complication [1]. Nephropathy is regarded as the most serious late diabetic complication because it is associated with 100 times greater risk of mortality than in the background population [2]. The median survival period of diabetic patients after onset of overt albuminuria was reported as less than 10 years [3]. In 1963, a sensitive method for detecting urinary albumin in low concentrations was described [4], and since then, many studies have been performed to establish the rate of urinary albumin excretion (UAE) that is predictive of later nephropathy. It was concluded from several reports that a cut-off level of 20 μg/min would include almost 80% of the patients at risk [5][6][7]. A rate of UAE between 20 and 200 (μg/min was therefore defined as microalbuminuria and is thought to signify incipient nephropathy [8]. Previous studies have shown recognizable variations in the prevalence of microalbuminuria in diabetic patients and have been inconclusive regarding the relationship between UAE and metabolic control [9][10][11][12]. The aim of the present study was to determine the prevalence of at risk values of UAE in young Sudanese diabetic patients and to explore its relation to age and glycemic control. Subjects and Methods SubjectsThe subjects were selected from the children and adolescents with type 1 diabetes who regularly attend the diabetic clinic at the University Hospital in Khartoum, Sudan. The patients who were between nine and 18 years of age and who had the disease for more than one year (62 children) were invited to participate in the study. Thirty heal...

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“…There also exists a positive correlation between albumin excretion rate and the grade of diabetic retinopathy (Barnett et al 1985;Gatling et al 1988;N0&aard et al 1988;Agardh et al 1989;Nielsen et al 1990), and microalbuminuria may predict proliferative retinopathy (Mogensen et al 1985).…”

mentioning

confidence: 99%

Impaired contrast sensitivity in adolescents and young Type 1 (insulin‐dependent) diabetic patients with microalbuminuria

Bangstad¹,

Brinchmann‐Hansen

Hultgren

et al. 1994

Acta Ophthalmologica

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We compared neurosensorial visual function by psychophysical tests (macular recovery time and contrast sensitivity) in two well matched groups of young Type 1 (insulin-dependent) diabetic patients with micro- and normoalbuminuria, respectively. The patients had normal visual acuity (> or = 1.0) and either no retinopathy or non-proliferative retinopathy. Thirty patients with microalbuminuria (albumin excretion > or = 15 micrograms/min in a least two out of three timed overnight urine samples) were matched (age, diabetes duration, mean one-year HbA1c, gender) with normoalbuminuric (n = 27) patients. Retinopathy (50 degree colour fundus photography) was assessed by counting microaneurysms and hemorrhages as 'red spots'. Contrast sensitivity was examined for the spatial frequencies of 1.5, 3, 6, 12 and 18 cycles per degree (cpd). Macular recovery time (nyctometry) refers to the time-related (2 min) ability of the retina to regain visual acuity following exposure to bright light (photostress). Contrast sensitivity score was reduced in patients with microalbuminuria compared to those without; 18 cpd (mean and 95% confidence intervals): [4.2 (3.8-4.7) vs 5.0 (4.6-5.4), p = 0.03]. Macular recovery performance was not significantly reduced: [21.0 arbitrary units (17.5-24.6) vs 26.0 (22.6-30.7), p = 0.12]. We conclude that impaired contrast sensitivity independent of background retinopathy is shown in a group of young Type 1 (insulin-dependent) diabetic patients with low-grade microalbuminuria compared to a group of patients with normoalbuminuria.

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Microalbuminuria and Diabetic Retinopathy

Cited by 55 publications

References 5 publications

Loss of visual function associated with microalbuminuria in diabetes mellitus

Loss of visual function associated with microalbuminuria in diabetes mellitus

Microalbuminuria in Young Sudanese Patients with Type 1 Diabetes

Impaired contrast sensitivity in adolescents and young Type 1 (insulin‐dependent) diabetic patients with microalbuminuria

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