Endocrine Abstracts

Background

There is a well-recognized association between diabetic retinopathy (DN) and diabetic nephropathy (DN), in which nephropathy without retinopathy is rare but retinopathy without nephropathy is common.

Aim

To highlight the discordance between retinopathy and nephropathy and describe a series of patients with diabetic nephropathy who had no evidence of diabetic retinopathy.

Methods

110 type 2 diabetes patients with diabetic nephropathy were studied retrospectively. Patients with clinical suspicion of non diabetic nephropathy were excluded. The patient’s age, gender, body mass index, duration of diabetes, glycosylated hemoglobin (HbA1c), low density lipoprotein cholesterol and presence of diabetic peripheral neuropathy were determined.

Results

Of the study population, 31 patients (28.18%) had no evidence of diabetic retinopathy. 51.61% were male. Median age was 56 ± 15 years. The mean duration of diabetes was 12 ± 5 years, mean body mass index was 28.72 ± 4.3 kg/m² (overweight), mean low density lipoprotein cholesterol was 1.25 ± 0.3 g/l. All patients had poor glycemic control with a mean HbA1c of 10.3%, 51.61% had treated hypertension, 32.26% had diabetic peripheral neuropathy. 58.06% had albuminuria without renal failure, 41.92% had renal failure without albuminuria: mean estimated glomerular filtration rate (eGFR) was 50 lm/min/1.73 m².

Conclusion

We have identified a subset of patients with diabetic nephropathy but who are protected from retinopathy. It is possible that there is an extreme phenotype of diabetic patients with unaffected eyes who carry genes protecting against DR.