Absence Of Diabetic Retinopathy Research Articles

Trajectories of choriocapillaris perfusion in healthy individuals and patients with diabetes mellitus: a prospective cohort study

PurposeTo evaluate the longitudinal rate of choriocapillaris flow deficits (CFD) in healthy participants and patients with diabetes mellitus.MethodsThis prospective cohort study included healthy individuals and diabetic patients without diabetic retinopathy...

Incidence of diabetic retinopathy in anti-tnf treated rheumatic disease patients with type 2 diabetes.

This study aimed to evaluate the impact of anti-TNF (biological) therapies on the incidence and progression of diabetic retinopathy. A cross-sectional analysis of 50 diabetic patients with rheumatic diseases (group 1) was performed. An age-, sex-, and HbA1c-matched control group (group 2) was formed from a pool of diabetic patients who underwent regular eye examinations. The presence or absence of diabetic retinopathy was also assessed. Comorbidities such as hypertension, coronary artery disease, and hyperlipidemia were also evaluated as possible confounding factors. Hundred eyes of 50 patients were evaluated in each group. Only three patients in group 1 had non-proliferative retinopathy. The median duration of rheumatic disease was 9 years, whereas that of diabetes was 11 years. The mean duration of anti-TNF therapy was 4 years. In the control group of diabetes-only patients, 13 patients developed some form of newly diagnosed diabetic retinopathy during the last five years. The calculated retinopathy occurrence between the groups was statistically significant (p < 0.05). In this study, the incidence rate ratio for patients receiving anti-TNF treatment was calculated as 0.4 in the study. TNF inhibitors, with their anti-inflammatory effects, positively impact diabetic complications by reducing the incidence of retinopathy. To our knowledge, this is the first study to evaluate retinopathy development after anti-TNF therapy.

#1671 Prevalence and factors predicting non diabetic kidney disease in type 2 diabetic patients

Abstract Background and Aims Renal involvement in type 2 diabetes is mostly presumed to be due to diabetic nephropathy, however a significant majority of diabetic patients can have pure non diabetic kidney disease (NDKD) or NDKD superimposed on diabetic kidney disease (DKD). Kidney biopsy cannot be routinely performed for all diabetic patients and hence short of conclusive biomarkers we need to explore various factors that can predict the occurrence of NDKD. Method We conducted a retrospective review of all native kidney biopsies conducted in patients with type 2 diabetes at our institute to identify the prevalence and factors that predict NDKD. The demographic data, clinical data, laboratory parameters, and histological results of the patients were obtained from their medical records. Binary logistic regression analysis was performed to evaluate the predictive factors for NDKD. Patients were categorized into 3 groups-DKD alone (presence of Kimmelstiel-Wilson nodules, capsular drops, fibrin caps and absence of any other NDKD features), NDKD along (presence of vasculopathy, interstitial fibrosis and specific glomerular changes in absence of classical DKD changes) and lastly DKD+NDKD (presence of histological changes of both DKD+NDKD). Results We analyzed a total of 69 patients. The mean (SD) age of the cohort was 51.94 ± 12.7 years and males constituted the majority (68%). Around 2/3rd of the entire cohort had hypertension, with no significant differences among the groups. Mean 24-hour urinary proteinuria was 6.6 ± 4.9 g/TV and 15.9% patients had microscopic hematuria. The mean (SD) duration of diabetes was 6.9 ± 6.2 years. Patients with pure DKD, pure NDKD and NDKD superimposed on DKD constituted 46.3%, 33.3% and 20% respectively of the cohort. The most common indication for renal biopsy in our cohort was rapid GFR decline in 38 patients (54.2%), followed by massive proteinuria in 27 (38.5%) and lastly positive serological work up for multiple myeloma in 5 patients (7.1%). Around 2/3rd of pure DKD patients in our cohort had diabetic retinopathy (DR), whereas only around 1/5th (26%) of pure NDKD patients had DR (p=0.005). DR was absent in around 74% of our diabetic patients who had pure NDKD. Non diabetic kidney disease in our cohort was seen in 46.3% patients and combined with DKD in 20% of patients. Among patients with NDKD, the most common cause was membranous glomerulonephritis (MGN) (43.4%) followed by acute tubulointerstitial nephritis (ATIN) (17.3%). Among combined DKD and NDKD, most common histological diagnosis was MGN (32.4%) followed by ATIN (16.2%). Independent factors predicting NDKD were shorter duration of diabetes (OR 0.74, CI 0.59–0.94, P=0.01) and absence of diabetic retinopathy (OR 0.15, 95% CI 0.09–0.26, P = 0.01). Conclusion Judicious use of kidney biopsy revealed NDKD in nearly half of T2DM patients especially in those with short duration of diabetes and absence of diabetic retinopathy (DR). Kidney biopsy is strongly recommended for T2DM patients with atypical presentation and in absence of DR.

#1626 The role of sodium-glucose cotransporter 2 inhibitors in diabetic nephropathy and non diabetic renal disease in diabetes mellitus type 2 patients

Abstract Background and Aims Diabetes Mellitus type 2 (DM2) leads to chronic kidney disease in a 30-40% of diabetic patients and it is the major cause of end stage renal disease (ESRD). The clinical course of diabetic kidney disease is very heterogeneous and there is a lack of agreement between clinical parameters and renal histology. Besides, lesions of non-diabetic kidney disease (NDRD) can coexist with lesions of diabetic nephropathy (DN) in two-thirds of kidney biopsies in patients with diabetes. There is not a specific treatment against diabetic kidney disease, treatment based in the blockade of renin-angiotensin-aldosterone system has demonstrated a delay of kidney function decline but the diabetic kidney disease is still the main cause of renal replacement by dialysis. Recently, a new class of oral glucose -lowering drugs, sodium-glucose cotransporter 2 (SGLT2) inhibitors, have shown beneficial effects into cardiovascular protection and chronic kidney disease in diabetic patients but it is not clear the beneficial effect in DN. The aim of this study is to evaluate the role of SGLT2 inhibitors in diabetic patients with DN biopsy-confirmed and compare with a group of diabetic patients with NDRD (DN and superimposed non diabetic renal disease lesions, NDRD). Method This is a retrospective study with DM2 patients and kidney biopsy performed. Patient demographic characteristics were recorded and diagnosis of Hypertension, duration of DM2, presence or absence of diabetic retinopathy (DR), macrovascular disease and treatment with renin–angiotensin– aldosterone system blockers (RAASB), oral hypoglycaemic agents, insulin, and aldosterone antagonists. Histological lesions were recorded according to the pathologic classification of DN. Renal function was based on estimated filtration rate CKD-EPI (eGFR mil/min/m2), the urine albumin-creatinine ratio (UACR mg/gr) and the 24 h proteinuria (g/24 h). Diabetic patients were classified according to the kidney biopsies in DN and NDRD. The follow up was assessed at the time of sodium-glucose cotransporter 2 (SGLT2) inhibitors started, 6, 12 and 24 months. Results A total of 64 DM2 patients with kidney biopsy were included in the study. Basal characteristics are summarized in Table 1. DN was diagnosed in 47% and NDRD in 53% of DM2 patients. DM2 patients with NDRD were older (64 ± 10 vs 70 ± 10, p = 0.017), and with more macrovascular disease than patients with DN, 6 (20%) vs 15 (44%), p = 0.04. Instead, DM2 patients with DN showed higher uACR levels than NDRD (2355 ± 2540 vs 706 ± 730, p = 0.02). A 40% of DM2 patients with DN were classified in nodular sclerosis class III of glomerular classification of DN. Interstitial fibrosis and tubular atrophy score were higher in DN versus NDRD patients, (interstitial fibrosis 12 (40%) vs 3 (9%), p = 0.006, tubular atrophy 10 (33%) vs 3 (9%), p = 0.02, Table 2. At the end of follow up, 20% of DM2 patients developed ESRD. According SGLT2 inhibitors treatment, a higher proportion of ESRD and death were observed in DM2 patients without SGLT2 inhibitors than patients with SGLT2 inhibitors, ESRD 11 (39%) vs 2 (6%), p = 0.001, death 9 (32%) vs 4 (11%), p = 0.03. Serum creatinine levels were lower in DM2 patients with SGLT2 inhibitors (118 ± 63.7 vs 203 ± 80.7, p = 0.001), but no differences was observed in uACR between groups. A significant reduction in serum creatinine levels with better eGFR were observed in both groups (DN and NDRD) under SGLT2 inhibitors comparing to group without SGLT2 inhibitors, serum creatinine levels 124 ± 78 vs 236 ± 83, p = 0.008, 107 ± 40 vs 201 ± 110, p = 0.02, and eGFR mil/min/m2 60.9 ± 27.5 vs 25.1 ± 7.2, p = 0.004, 62.6 ± 21.2 vs 33.7 ± 16.2, p = 0.005, Table 3. Conclusion A higher proportion of DM2 showed NDRD lesions in kidney biopsy. Treatment with SGLT2 inhibitors reduced progression of chronic renal disease in DN and NDRD DM2 patients. A reduced progression to ESRD and death were also observed in NDRD DM2 patients with SGLT2 treatment.

Determinants of non-diabetic kidney diseases in type 2 diabetic patients: Twenty years of single center experience.

Diabetic nephropathy is one of the most common complications associated with diabetes. However, non-diabetic kidney disease has been reported in patients with type 2 diabetes at varying incidence rates. The objective of our study is to investigate the occurrence, clinicopathological characteristics, and inflammatory markers linked to diabetic and non-diabetic nephropathy (NDN) in patients with type 2 diabetes mellitus (DM). Additionally, we aimed to explore the possibility of identifying non-diabetic pathology using different biopsy indications. A total of 159 patients with type 2 DM who underwent renal biopsy at a tertiary care nephrology clinic between January 2000 and January 2022 were enrolled in the study. We collected comprehensive data, including patient demographics, co-morbidities, diabetes duration, renal biopsy indications and results, serological markers, renal function, diabetic retinopathy (DRP), full blood count, blood biochemistry, urinalysis, and inflammatory markers. Patients were categorized based on their biopsy indications, and their biopsy results were classified into three groups: isolated NDN, isolated diabetic nephropathy (DN), and mixed nephropathy with concurrent NDN. We evaluated the relationship between biopsy indications and accompanying pathologies and statistically assessed the likelihood of each biopsy indication detecting non-diabetic renal pathology. Additionally, differences in other data, including demographic and laboratory results and medical histories, among the three groups were investigated. The most frequent indication of renal biopsy was atypical presentations of nephrotic syndrome or nephrotic range proteinuria (ANS/ANP) in 25.1% of patients. Other indications included unexplained renal failure (URF) in 22.6%, atypical presentations of non-nephrotic range proteinuria (ANNP) in 18.2%, acute kidney injury or rapidly progressive kidney dysfunction (AKI/RPKD) in 16.9%, microscopic hematuria in 15.7%, URF with ANNP in 11.3%, and severe nephrotic range proteinuria (SNP) in 9.4%. Renal biopsy revealed isolated NDN in 64.8%, DN in 25.1%, and mixed nephropathy in 10.1% of patients. Primary glomerular diseases were the main non-diabetic renal pathology, predominantly focal segmental glomerulosclerosis (FSGS) (36.4%) followed by MN (10.6%) and IgA nephropathy (7.5%). In comparison with the isolated DN and mixed nephropathy groups, patients in the isolated NDN group had significantly shorter diabetes duration, fewer DRP, as well as lower serum creatinine and neutrophil-to-lymphocyte ratio (NLR). Multivariate logistic regression analysis revealed that presence of hematuria (OR 4.40; 95% CI 1.34 - 14.46, p = 0.014), acute nephrotic range proteinuria (OR 11.93; 95% CI 1.56 - 90.77, p = 0.017), and AKI/APKD (OR 41.08; 95% CI 3.40 - 495.39, p = 0.003) were strong predictors of NDN. Lower NLR (OR 0.77; 95% CI 0.60 - 0.98, p = 0.035), shorter duration of diabetes (OR 0.90; 95% CI 0.84 - 0.97, p = 0.010), and absence of DRP (OR 0.35; 95% CI 0.12 - 0.98, p = 0.046) were also found to be independent indicators of NDN. Receiver operating characteristic curve (ROC) analysis revealed a cut-off value of ≤ 3.01 for NLR (sensitivity of 63.1%, specificity of 63.5%) with regards to predicting non-diabetic renal pathology (p = 0.006). Renal biopsy findings in patients with type 2 DM highlight that the prevalence of NDN may be higher than assumed, as presented mainly in the form of primary glomerular disease. The presence of AKI/RPKD, hematuria, and ANS/ANP serves as a reliable indicator of non-diabetic renal pathology. In more ambiguous situations, factors such as a shorter duration of diabetes, absence of DRP, and a lower NLR value may assist clinicians in biopsy decision.

Non-diabetic nephropathy in diabetic patients: incidence, HbA1c variability and other predictive factors, and implications.

Diabetes mellitus (DM) is the leading cause of chronic kidney disease (CKD) in the population. In patients with diabetes mellitus, the incidence of non-diabetic nephropathy (NDNP) has been estimated to range from 3% to 69.5%. Personal judgment is frequently employed while deciding whether or not to do a kidney biopsy(KB) on diabetic patients. NDNP alters the prognosis and course of treatment for people with DM. In our study, we examined the incidence of NDNP concurrent with the progression of diabetes mellitus, as well as the laboratory and clinical indicators that could be utilized to forecast it. A retrospective analysis of 76 diabetic patients who underwent KB was conducted. Based on the pathological diagnoses of these patients, they were categorized as DNP (diabetic nephropathy) or NDNP. The definition of HbA1c variability was determined by calculating the mean HbA1c and the average value of the HbA1c measurements, as well as the standard deviation (SD) for each participant. NDNP was detected in 50% of 76 patients. Among patients with NDNP, 36.8% had focal segmental glomerulosclerosis (FSGS), 23.6% had membranous glomerulonephritis, and 7.8% had IgA nephritis. The NDNP group exhibited significantly higher rates of female gender, absence of diabetic retinopathy, shorter time to diagnosis of diabetes mellitus, chronic kidney disease, and proteinuria, less intensive medication for diabetes mellitus, presence of hematuria and leukociduria, immunological serological marker positivity, and non-HbA1C variability. Risk factors for predicting non-diabetic nephropathy, as determined by multivariate analysis, included female gender, the absence of diabetic retinopathy, non-HbA1c variability and a positive immunological serological test. In this study, a significant number of diabetic patients with chronic kidney disease were diagnosed with NDNP. Identifying these patients allows for treatment of the specific underlying disease. Factors such as the absence of DR, non-HbA1c variability, female gender, and immunological serological test positivity can predict NDNP and guide the clinician's decision on kidney biopsy. Further prospective studies are warranted to validate the efficacy of potential predictive factors like HbA1c variability.

Prevalence and Factors Predicting Nondiabetic Kidney Disease in Type 2 Diabetic Patients

ABSTRACT Background: Renal involvement in type 2 diabetes is mostly presumed to be due to diabetic nephropathy; however, a significant majority of diabetic patients can have pure nondiabetic kidney disease (NDKD) or NDKD superimposed on diabetic kidney disease (DKD). Kidney biopsy cannot be routinely performed for all diabetic patients, and hence, short of conclusive biomarkers, we need to explore various factors that can predict the occurrence of NDKD. Methods: We conducted a retrospective review of all native kidney biopsies conducted in patients with type 2 diabetes at our institute to identify the prevalence and factors that predict NDKD. The demographic data, clinical data, laboratory parameters, and histological results of the patients were obtained from their medical records. Binary logistic regression analysis was performed to evaluate the predictive factors for NDKD. Results: We analyzed a total of 69 patients. The mean (standard deviation) age of the cohort was 51.94 ± 12.7 years and males constituted the majority (68%). Patients with pure DKD, pure NDKD, and NDKD superimposed on DKD constituted 46.3%, 33.3%, and 20%, respectively, of the cohort. Around two-third of pure DKD patients in our cohort had diabetic retinopathy (DR), whereas only around one-fifth (26%) of pure NDKD patients had DR (P = 0.005). Membranous glomerulonephritis (MGN) was the most common histological lesion in the NDKD group (43%), followed by acute tubulointerstitial nephritis (ATIN) (17.3%). Among combined DKD and NDKD, the most common histological diagnosis was pyelonephritis (28.6%), followed by MGN and ATIN (14.3%). Independent factors predicting NDKD were shorter duration of diabetes (odds ratio [OR] = 0.74, confidence interval [CI] =0.59–0.94, P = 0.01) and absence of DR (OR = 0.15, 95% CI = 0.09–0.26, P = 0.01). Conclusion: Kidney biopsy revealed NDKD in nearly half of type 2 diabetes mellitus (T2DM) patients, especially in those with short duration of diabetes and absence of DR. Kidney biopsy is strongly recommended for T2DM patients with atypical presentation and in the absence of DR.

MATHEMATICAL MODELING OF ASSESSMENT OF THE PROBABILITY OF THE DEVELOPMENT AND PROGRESSING OF DIABETIC MACULAR EDEMA IN PATIENTS WITH TYPE 2 DIABETES

Background. The participation of fractalkine, clusterin and sICAM in the pathogenesis of diabetic complications of the fundus was established. The development of methods of mathematical assessment of the prognosis of the development and course of diabetic macular edema (DME) with the participation of these cytokines is an actual problem of modern ophthalmology and endocrinology.&#x0D; Aim: To develop the prognostic mathematical models for assessing the probability of development and progression of DME in patients with diabetes mellitus (DM) type 2 based on the study of the content of blood serum fractalkine, clusterin and sICAM-1.&#x0D; Material and methods. A single-center selective one-moment open observational study of 82 patients (145 eyes) with DME in type 2 diabetes, divided into 4 groups according to the severity of DME, was conducted. The average age of the patients was 65.25±10.85 years, the average duration of diabetes was 14.0±7.05 years (±SD). The concentration of blood serum fractalkine (Frl), clusterin (Cls) and sICAM-1 was determined by the ELISA, and an instrumental examination of the fundus was performed. Multivariate discriminant analysis was used with the “SPSS 9.0” program. Differences at p&lt;0.05 were considered statistically significant. 3 models with linear combinations of the investigated indicators were developed and corresponding formulas of classification functions (FC) were obtained.&#x0D; Results. Models for assessing the risk of DME development and progression in patients with type 2 DM characterize by the fact that, at the first stage, fix the duration of diabetes mellitus (DD), and measure the concentration of blood serum fractalkine, clusterin, and sICAM-1. Further, with the helpness of ophthalmoscopy, determine the presence and severity of DMN, assigning the code 1 - the presence of concomitant diabetic retinopathy (DRP), the code 2 - the absence of DRP. At the final stage, calculate the classification functions FK1 and FK2 or FK2 and FK3 (depending on the model), compare FK1 with FK2 or FK2 with FK3, and determine which of them is larger according to the appropriate formulas. Moreover, the prognostic decision takes as the choice of the FC that is more important. So, if FK1&gt;FK2, the prognosis is possible the stabilization of the pathological process, and if FK2&gt;FK1 or FK3&gt;FK2, then the prognosis is the probability of progression of the DME.&#x0D; The main model is presented below:&#x0D; FK1DME(0) = -111,278 + 8,57411*Frl + 0,562616*Cls + 0,257994*sICAM -0,139202*DD +7,72433*DRP&#x0D; FK2DME(1) = -101,108 + 8,5887* Frl + 0,544401* Cls + 0,235155*sICAM + +0,0261057*DD + 10,1873*DRP&#x0D; FK3DME(2+3) = -105,68 + 9,06663* Frl + 0,552074* Cls + 0,241348*sICAM -0,102963*DD + 11,8493*DRP&#x0D; Conclusion. The informativeness of mathematical models for assessing the prognostic significance of serum cytokines fractalkine, clusterin and sICAM-1 in the development and progression of DME in patients with type 2 diabetes is 62.5-77.5%, depending on the type of model.

Study Ocular Hemodynamics in Pregnant Women with Disorders of Carbohydrate Metabolism

Purpose. To study state of ocular hemodynamics in pregnant women with disorders of carbohydrate metabolism using color Doppler imaging. Patients and methods. 147 pregnant women were examined: 40 of them had type 1 diabetes mellitus (DM), 87 had gestational diabetes (GD); in 20 — pregnancy proceeded physiologically. Examination of pregnant women with DM was carried out in each trimester and 3 months after delivery, pregnant women with GD and control groups — once in the third trimester. The parameters of hemodynamics in the central retinal artery (CRA) and in the short posterior ciliary arteries (SPCAs) were studied using color Doppler imaging. Results. It was found that the peak systolic velocity (PSV) in the CRA was significantly lower in the GD and DM groups, while PSV in the SPCAs and end-diastolic velocity (EDV) in the CRA were higher in the control group compared to the GD. In SPCAs, the resistive index (RI) was the highest in the DM group, and the lowest in the GD group. Conclusion. In patients with GD in the third trimester of pregnancy, there is a statistically significant decrease in PSV and EDV in the CRA and SPCAs, combined with a decrease in RI in SPCAs, compared with patients with a physiological course of pregnancy. In patients with diabetic retinopathy (DR) in the third trimester of pregnancy, PSV and EDV in the CRA and SPCAs were significantly lower, and the pulsatility index (PI) and RI were significantly higher compared to pregnant women with DM without DR. In pregnant women with DR during gestation, there was a decrease in PSV and EDV against the background of an increase in RI and PI in the CRA and in the SPCAs. In pregnant women with DM and absence of DR during gestation, there was an increase in PSV, EDV and PI in the CRA and SPCAs from the first to the third trimesters. The revealed features of the state of hemodynamics in the CRA and SPCAs in pregnant women with DM with presence or absence of DR can become the basis for creating criteria for manifestation and progression of DR.

Incidence, Histopathological Pattern, and Predictors of Non-Diabetic Renal Disease in Type 2 Diabetes Mellitus: A Single-Center Prospective Observational Study

Patients with type 2 diabetes mellitus (T2DM) may have renal involvement because of isolated diabetic nephropathy (DN), isolated non-diabetic renal disease (NDRD), or mixed lesions (DN combined with NDRD). This study was conducted to find out incidence, histopathological pattern, and clinical predictors of NDRD in the Kashmiri population. This is a single-center prospective observational study conducted from August 2015 to July 2017. Patients with T2DM presenting with atypical clinical features of renal involvement underwent kidney biopsy. A total of 33 patients were included. Isolated NDRD was found in 16/33 (48.5%) patients, isolated DN was discovered in 10/33 (30.3%), and mixed lesions in 7/33 (21.2%) patients. NDRD with or without DN was present in 23/33 (69.7%) patients. Overall, the most common renal histopathological lesion in NDRD was immunoglobulin A (IgA) nephropathy present in 7/23 (30.4%) patients. In mixed lesions, FSGS and TMA were the most common renal lesions present in 2/7 (28.57%) patients. The mean duration of diabetes in NDRD and isolated DN groups was 4.4±3.6 and 7.0±2.9 years, respectively (P = 0.04). NDRD was present in 21/23 (91.3%) patients without diabetic retinopathy (P = 0.016). Our data demonstrated that more than half of the patients with T2DM with atypical features had NDRD upon renal biopsy. The absence of diabetic retinopathy and a shorter duration of diabetes were indicators of NDRD. IgA nephropathy was the most prevalent renal pathology. Clinicians must consider kidney biopsy liberally, especially in patients with unclear etiology of a kidney disease. Patients with type 2 diabetes mellitus (T2DM) may have renal involvement because of isolated diabetic nephropathy (DN), isolated non-diabetic renal disease (NDRD), or mixed lesions (DN combined with NDRD). This study was conducted to find out incidence, histopathological pattern, and clinical predictors of NDRD in the Kashmiri population. This is a single-center prospective observational study conducted from August 2015 to July 2017. Patients with T2DM presenting with atypical clinical features of renal involvement underwent kidney biopsy. A total of 33 patients were included. Isolated NDRD was found in 16/33 (48.5%) patients, isolated DN was discovered in 10/33 (30.3%), and mixed lesions in 7/33 (21.2%) patients. NDRD with or without DN was present in 23/33 (69.7%) patients. Overall, the most common renal histopathological lesion in NDRD was immunoglobulin A (IgA) nephropathy present in 7/23 (30.4%) patients. In mixed lesions, FSGS and TMA were the most common renal lesions present in 2/7 (28.57%) patients. The mean duration of diabetes in NDRD and isolated DN groups was 4.4±3.6 and 7.0±2.9 years, respectively (P = 0.04). NDRD was present in 21/23 (91.3%) patients without diabetic retinopathy (P = 0.016). Our data demonstrated that more than half of the patients with T2DM with atypical features had NDRD upon renal biopsy. The absence of diabetic retinopathy and a shorter duration of diabetes were indicators of NDRD. IgA nephropathy was the most prevalent renal pathology. Clinicians must consider kidney biopsy liberally, especially in patients with unclear etiology of a kidney disease.

#6834 PREVALENCE, ETIOLOGY AND CLINICAL CHARACTERISTICS OF BIOPSY PROVEN NON-DIABETIC RENAL DISEASE: 10 YEARS OF BIOPSES IN DIABETIC PATIENTS

Abstract Background and Aims Diabetic nephropathy (DN) is the major cause of kidney disease in diabetic patients. However, a significant proportion of diabetic patients may actually have nondiabetic renal disease (NDRD). Therefore, it is important to identify patients who can benefit from a renal biopsy in order to establish the correct diagnosis. Our study aims to determine the prevalence and etiology of biopsy proven NDRD and to explore the clinical differences encountered in the diabetic patient with NDRD. Method Retrospective study of the medical records of all diabetic patients who underwent a renal biopsy due to suspicion of NDRD from January 2012 to December 2022 at Nephrology department Collected data comprised demographic information, indication and result of renal biopsy, lab results (serum creatinine, Hb1Ac, proteinuria, albuminemia, hematuria, presence of active urinary sediment and presence of auto antibodies) and disease's characteristics (duration of diabetes, presence of diabetic retinopathy). Categorical variables are presented as frequencies and percentages, continuous variables as means and standard deviations, or medians and interquartile ranges (IQR) for variables with skewed distributions. A p-value&amp;lt;0.05 was considered statistically significant. Statistical analysis was performed using SPSS version 28.1 for Mac OS X. Results 57 patients, 33.3% (n=19) were females, the medium age was 64.9 $\langle {{\rm{italic}}} \rangle \pm \langle {/{\rm{italic}}} \rangle $ 12.1. The most frequent indication for renal biopsy was acute kidney injury (26.3%), followed by rapidly progressive renal failure and nephrotic syndrome (22.8%). In our population, 22.9% had DN and 77.4% had NDRD. Pauciimune Glomerulonephritis (14%) and Membranous Nephropathy (10.5%) were the most common causes of NDRD. A chi-square test was performed to examine the relation between the two groups (ND vs NDRD) and the presence of diabetic retinopathy. There was a statistically significant association between the two variables ($\langle {{\rm{italic}}} \rangle {{\rm{X}}}^2\langle {/{\rm{italic}}} \rangle $= 11.778, p&amp;lt;0.01). Mann-Whitney test was performed to compare the median of duration the diabetes and Hb1Ac in two groups. That showed a statistically significant difference (U = 357, P = .018 and U=335.5 P = .013 respectively). Conclusion Since renal biopsy is critical to establish the correct diagnosis and provide an appropriate treatment, it should be performed in patients with high suspicion of NRDN, especially in patients with a recent diagnosis of diabetes, good metabolic control and the absence of diabetic retinopathy.

#5201 KIDNEY BIOPSY IN PATIENTS WITH TYPE 2 DIABETES: A SINGLE CENTER OBSERVATIONAL STUDY

Abstract Background and Aims Patients with type 2 diabetes mellitus (T2DM), may have various underlying causes contributing to kidney disease beyond diabetic nephropathy (DN). In such cases, a kidney biopsy (KB) can provide a definite diagnosis and allow for tailored treatment options. The aim of this study is to evaluate non diabetic kidney disease (NDKD) in T2DM patients and identify data to support KB indications. Method This is a retrospective observational study that included patients with T2DM who were submitted to a native KB between 2011 and 2022. We collected demographic, clinical and laboratory data at the date of biopsy. KB indication was considered in order to include the patients in the first encountered criteria defined sequentially as the presence of (1) nephrotic syndrome, (2) low or rapidly declining estimated glomerular filtration rate (eGFR), (3) nephrotic proteinuria and (4) hematuria. Results We analysed 72 patients with T2DM that were submitted to KB (Table 1). All except one patient had hypertension and 38 patients were screened for diabetic retinopathy (DR), which was present in 23 patients (60%). The criteria for KB was in most of the patients (59.7%) a low or rapidly declining eGFR, followed by nephrotic proteinuria (19.4%), nephrotic syndrome (16.7%) and hematuria (4.2%). KB showed 50% (n = 36) of patients with NDKD, 12.5% (n = 9) with NDKD and DKD and 37.5% (n = 27) with isolated NDKD. Among these patients, hypertensive nephrosclerosis (19.4%), focal segmental glomerulosclerosis (13.8%), acute interstitial nephritis (13.8%), membranous nephropathy (11.2%) and IgA nephropathy (5.6%), were the most prevalent diagnosis. Patients with DR had a higher prevalence of DKD with a positive predictive value (PPV) of 87%. On the other hand, in the absence of DR, DKD was only absent in 66.7%. Patients submitted to KB for the criteria of low or rapid declining eGFR had significantly more NDKD (p = 0.016). DKD with or without NDKD was found in patients with higher levels of albumin to creatinine ratio (p = 0.001) and HbA1c (p = 0.05). Conclusion Our data showed that NDKD is prevalent in T2DM patients, and given its potentially treatable nature, KB should be considered in T2DM patients, especially in those with low or rapid declining eGFR. DR supports the diagnosis of DKD (PPV of 87%), but alone is insufficient to exclude other causes. Patients with DKD had higher levels of albuminuria and HbA1c. Overall, more than half of the patients had hematuria, without any correlation with any group.

Diabetic Retinopathy Screening Using Non-Mydriatic Fundus Camera in Primary Health Care Settings - A Multicenter Study from Saudi Arabia.

Screening of diabetic retinopathy (DR) using the current digital imaging facilities in a primary health care setting is still in its early stages in Saudi Arabia. This study aims to reduce the risk of vision impairment and blindness among known diabetic people through early identification by general practitioners (GP) in a primary health care setting in Saudi Arabia. The objective of this study was to evaluate the accuracy of diabetic retinopathy (DR) detection by general practitioners (GPs) by comparing the agreement of DR assessment between GPs and ophthalmologists' assessment as a gold standard. A hospital-based, six-month cross-sectional study was conducted, and the participants were type 2 diabetic adults from the diabetic registries of seven rural PHCs, in Saudi Arabia. After medical examination, the participants were then evaluated by fundus photography using a non-mydriatic fundus camera without medication for mydriasis. Presence or absence of DR was graded by the trained GPs in the PHCs and then compared with the grading of an ophthalmologist which was taken as a reference or a gold standard. A total of 899 diabetic patients were included, and the mean age of the patients was 64.89 ± 11.01 years. The evaluation by the GPs had a sensitivity of 80.69 [95% CI 74.8-85.4]; specificity of 92.23 [88.7-96.3]; positive predictive value, 74.1 [70.4-77.0]; negative predictive value, 73.34 [70.6-77.9]; and an accuracy of 84.57 [81.8-89.88]. For the consensus of agreement the adjusted kappa coefficient was from 0.74 to 0.92 for the DR. This study demonstrates that trained GPs in rural health centers are able to provide reliable detection results of DR from fundus photographs. The study highlights the need for early DR screening programs in the rural areas of Saudi Arabia to facilitate early identification of the condition and to lessen impact of blindness due to diabetes.

Оценка макулярного кровотока с помощью оптической когерентной томографии-ангиографии у беременных женщин, страдающих сахарным диабетом

Purpose. To study retinal blood flow in pregnant women with disorders of carbohydrate metabolism using optical coherence tomography angiography (OCTA) in order to determine the criteria for the manifestation and progression of diabetic retinopathy (DR). Material and methods. 203 pregnant women in the third trimester were examined: 24 – with type 1 and 2 diabetes (T1D and T2D), 143 – with gestational diabetes (GD), and 36 apparently healthy women with physiological pregnancy, who consisted the control group. OCTA imaging was performed using the RTVue XR Avanti OCT 6 mm × 6 mm «Angio Retina» scan protocols (Optovue, USA). The whole image vessel density (wiVD), foveal vessel density (FVD), and foveal avascular zone (FAZ) area in the superficial capillary plexus were studied. Results. FVD in pregnant women with diabetes was significantly less than in pregnant women with GD and in the control group. In this connection, it can be assume changes of the retinal microvascular regulation, due to chronic disorders of carbohydrate metabolism in patients with diabetes, and development of microangiopathy. Enlargement of FAZ area and decrease of wiVD were revealed in patients with DR, relative to datas obtained in the group of pregnant women with diabetes and absence of DR, in the absence of differences in FVD indexes. In 2 patients with T1D and the absence of ophthalmoscopic signs of DR, OCTA revealed areas of nonperfusion in the posterior pole of the eye. Conclusion. OCTA helps to identify areas of retinal nonperfusion in the posterior pole of the eye in pregnant women with diabetes in the absence of ophthalmoscopic signs of DR and allows determining objective indications for timely retinal laser coagulation. Keywords: optical coherence tomography angiography, pregnancy, diabetic retinopathy, gestational diabetes, foveal avascular zone, retinal blood flow

Результаты изучения ретинального кровотока у беременных с сахарным диабетом с помощью оптической когерентной томографии-ангиографии

Purpose. To study retinal blood flow in pregnant women with disorders of carbohydrate metabolism using optical coherence tomography angiography (OCTA). Material and methods. 203 pregnant women in the third trimester of pregnancy were examined: 24 — with type 1 and 2 diabetes (T1D and T2D), 143 — with gestational diabetes (GD), and 36 healthy women with physiological pregnancy, who consisted the control group. OCTA imaging was performed using the RTVue XR Avanti OCT 6 mm × 6 mm «Angio Retina» scan protocols (Optovue, USA). The vascular density (VD), vascular density in the fovea (VDF), and foveal avascular zone (FAZ) area in the superficial capillary plexus were studied. Results. Among studied patients no significant differences in VD and in FAZ area were found. VDF in pregnant women with diabetes was significantly less than in pregnant women with GD and in the control group. There were no significant differences in the studied parameters in groups with different periods of GD manifestation. In pregnant women with diabetes with presence and absence of DR, retinal blood flow did not differ significantly. Given the absence of differences of studied parameters in pregnant women with diabetes without DR and with DR, it can be assumed that the retinal microvascular regulation changes due to chronic disorders of carbohydrate metabolism in patients with diabetes and the development of microangiopathy. In 2 patients with T1D and the absence of ophthalmoscopic signs of DR, OCTA revealed areas of nonperfusion in the posterior pole of the eye. Conclusion. OCTA helps to identify areas of retinal nonperfusion in the posterior pole of the eye in pregnant women with diabetes in the absence of ophthalmoscopic signs of DR. Keywords: optical coherence tomography angiography, pregnancy, diabetic retinopathy, retinal blood flow

Psychological Domain of Elderly Patients with Diabetic Retinopathy

The continuing increase in the prevalence of diabetic retinopathy among various segments of the population and, especially in older age, combined with a change in the psychological state of such patients. However, the study of the holistic psychological (cognitivedepressive) domain in elderly patients with various stages of diabetic retinopathy, comparable in cardiovascular pathology, which is an independent risk factor for both diabetic retinopathy and cognitive impairment, depression not carried out.Purpose: to assess the psychological domain in patients 60–74 years old suffering from diabetic retinopathy standardized for concomitant cardiovascular pathology. In the Tambov branch of the Tambov branch of S.N. Fedorov NMRC “MNTK “Eye Microsurgery” in 2019–2020, cognitive impairment and depression were studied in 68 patients with non-proliferative, 62 patients with preproliferative and 70 elderly patients with proliferative stage on the Mini-Mental-State-Examination and Center for Epidemiologic Studies — Depression scale, respectively. The diagnosis of diabetic retinopathy established based on the results of a comprehensive ophthalmological examination. The control consisted of 59 patients with the absence of diabetic retinopathy. Patients with non-proliferative stage had mild (21.5 ± 0.3 points), and with preproliferative (17.9 ± 0.4 points) and proliferative stage (16.2 ± 0.3 points) moderate cognitive impairment. The association of cognitive impairment found with preproliferative and proliferative diabetic retinopathy. The level of depression in the non–proliferative stage was 22.4 ± 0.4 points, in the preproliferative stage — 24.8 ± 0.3 points and in the proliferative stage — 26.9 ± 0.5 points versus 19.2 ± 0.3 points in the control with a significant difference in all cases. The values of the relative risk of diabetic retinopathy stages were 1,337, 2,408 and 2,796, respectively. The revealed deterioration of the cognitive-depressive domain in elderly patients with diabetic retinopathy is important for improving compliance, the effectiveness of treatment of diabetic retinopathy and the psychological continuum.

Non-Diabetic Kidney Disease in Type 2 Diabetes Mellitus: A Changing Spectrum with Therapeutic Ascendancy.

Owing to changing epidemiology and therapeutic practices, a change in the spectrum of renal involvement in Type-2 diabetes mellitus (T2DM) has also been noted. The treatment of non-diabetic kidney disease (NDKD) differs from diabetic kidney disease (DKD) and the reversibility of NDKD in many cases to normal, prompts biopsy for rapid and accurate diagnosis. Data are scarce on kidney biopsy findings in T2DM. In this observational study, we prospectively collected the data of kidney biopsies of patients aged ≥ 18 years with T2DM admitted between 1 August 2005 and 31 July 2022. The clinical, demographic and histopathological data were evaluated. The spectrum of kidney involvement in the form of DKD and/or NDKD was studied. The impact of these findings with the use of drugs retarding disease progression was also analyzed. A total of 5485 biopsies were performed during the study period and of these 538 patients had T2DM. The mean age of the study population was 56.9 ± 11.5 years and 81% were males. The mean duration of DM was 6.4 ± 6.1 years. Diabetic retinopathy (DR) was noted in 29.7%. The most common indication for biopsy was an acute rise in creatinine (147, 27.3%). Amongst the 538 diabetic patients who underwent biopsy, histological features only of DKD were noted in 166 patients (33%), NDKD alone in 262 (49%) and NDKD with DKD lesions in 110 (20%). On multivariate analysis, duration of DM less than 5 years, absence of CAD, absence of DR, oliguria at presentation, an acute rise in creatinine and low C3 were associated with NDKD. The prevalence of NDKD among diabetics and ATIN in particular might be on an increasing trend in the current era of changing T2DM epidemiological patterns. The use of anti-pro-teinuric agents was associated with lesser degrees of histopathological chronicity in T2DM.

Change in Contrast Sensitivity among Patients with Diabetic Mellitus Type II

Introduction: Eye being one of the target organs of diabetes mellitus has many pathological consequences, one possibly being contrast sensitivity. Contrast sensitivity is required for daily activities like in situations of low light, fog or driving at night. The study was conducted to find out contrast sensitivity among diabetic&#x0D; Methodology: A hospital based descriptive cross- sectional study of contrast sensitivity was conducted among type II diabetics with or without retinopathy at Kathmandu Medical College from April to December 2018. Patient demographics and comprehensive clinical examinations findings were recorded in a specially designed proforma. Convenience sampling was done and informed consent was taken.&#x0D; Leas symbol low contrast test 10M was used for contrast sensitivity testing. The contrast levels of the test lines on the five pages are 25%, 10%, 5%. 2.5%and 1.2%. Data was analyzed in excel and SPSS (version21). Results were expressed in frequency, percentage and mean as required. Association of contrast sensitivity with age, gender, duration of diabetes, blood sugar level and diabetic retinopathy was tested using chi square test.&#x0D; Results: Among the 45 study population, female to male ratio was 1:2. Age ranged from 25 to 76 years with maximum patients in the age group 51-60 years. Blood sugar was controlled in 33.33%. Contrast sensitivity was decreased in 40%. Among the patients with decreased contrast sensitivity, blood sugar was uncontrolled in 66.67%. Similarly, 72.2% of participants with decreased contrast sensitivity had no diabetic retinopathy. The association of contrast sensitivity with age of the patient, gender, duration of diabetes mellitus, blood sugar level and diabetic retinopathy was not statistically significant with p values 0.34, 0.52, 0.07, 1 and 0.89 respectively. &#x0D; Conclusion: Contrast sensitivity can be decreased among patients with type II diabetes mellitus irrespective of gender, age of the patient, duration of diabetes, control of blood sugar and presence or absence of diabetic retinopathy.

Hubungan Pengendalian Diabetes Melitus Type 2 Dengan Kejadian Retinopati Diabetes Di Rsud Dr Chasan Boesoirie Ternate

Background: Controlling type 2 diabetes mellitus (DMT2) is very important in reducing the possibility of complications. The incidence of complications of DMT2 includes macrovascular and microvascular. An important microvascular complication is diabetic retinopathy, which is strongly influenced by the duration of diabetes, hyperglycemia and hypertension. Many studies with mixed results regarding the relationship of controlled diabetes with the incidence of diabetic retinopathy. Purpose: This study aims to determine the relationship between T2DM control and the incidence of diabetic retinopathy at Dr Chasan Boesoirie Hospital Ternate. Methods: This study used an analytic observation design with a cross sectional approach. DMT2 patients who visit the internal medicine polyclinic are examined for HbA1c and examined by an ophthalmologist to diagnose the presence or absence of diabetic retinopathy. Samples were taken by purposive sampling. Correlation test analysis was carried out with the Chi Square test. Results: In DMT2 who visited the Internal Medicine Polyclinic at Dr. Chasan Boesoirie found. Conclusion: There is a non-significant relationship with p=0.179 between controlled T2DM and the incidence of diabetic retinopathy. Early detection of diabetic retinopathy is required by funduscopic examination with regard to the status of T2DM control

Contents of chemokines in lacrimal fluid of the patients with diabetic retinopathy and type 2 diabetes mellitus

Diabetic retinopathy is a serious microvascular complication of diabetes mellitus with chemokines playing an important pathogenetic role. However, the studies of chemokines in lacrimal fluid of the patients with diabetic retinopathy and type 2 diabetes mellitus (T2DM) are rarely performed. The aim of the study was to analyze the content of chemokines in lacrimal fluid of patients suffering from diabetic retinopathy and T2DM. When determining the concentration of chemokines in the lacrimal fluid, two clinical groups were formed: the main group of 56 elderly patients suffering from diabetic retinopathy and T2DM, and a control group of 48 age-matched persons with T2DM, however, without diabetic retinopathy. The diagnosis of diabetic retinopathy was performed after comprehensive ophthalmological examination using various modern techniques and applying the criteria of the All-Russian Association of Ophthalmologists “Diabetes mellitus: diabetic retinopathy, diabetic macular edema”. The chemokine levels in the lacrimal fluid were determined in the morning on the MAGPIX device (USA). The changed contents of chemokines was shown in lacrimal fluid of patients with diabetic retinopathy and T2DM, in comparison with patients suffering from T2DM in absence of diabetic retinopathy. In elderly patients with diabetic retinopathy and T2DM, a decreased content of GROα/ CXCL1, RANTES/CCL5 and MIP-1α/CCL3 was revealed in lacrimal fluid, at a statistically significant difference as related to controls. At the same time, the content of GROα/CXCL1 chemokine in lacrimal fluid was decreased most significantly, (38.24±2.57 in the main group versus 13.61±1.74 pg/mL in the comparison group). The level of RANTES/CCL5 decreased to 0.92±0.16 pg/mL versus 1.69±0.18 pg/mL (p &lt; 0.001); MIP-1α/CCL3, to 2.06±0.71pg/mL versus 3.79±0.64 pg/mL, respectively. However, the proportion of chemokines in the lacrimal fluid of patients with diabetic retinopathy and T2DM was significantly inceased in all cases. This finding concerns MCP-1/CCL2, IP-10/CXCL10, and SDF1α/CXCL12. The content of IP-10/CXCL10 in lacrimal fluid increased to maximal values of 38.24±2.57 pg/mL in the patients with diabetic retinopathy and T2DM compared with 13.61±1.74 pg/mL in patients with diabetes mellitus without diabetic retinopathy, MCP-1/CCL2 to 742.34±0.89 pg/mL compared to 633.72±0.64 pg/mL, respectively; SDF1α/ CXCL12, to 264.78±7.82 pg/mL compared to 213.49±6.08 pg/mL. In addition, the interrelations between studied chemokines in patients with diabetic retinopathy and type 2 diabetes mellitus are more pronounced than in comparison group as confirmed by large number of correlations in the main group. The results obtained expand the knowledge on the effects of chemokines in lacrimal fluid upon development of diabetic retinopathy.