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Sample records for hypertensive retinopathy microalbuminuria

  1. Hypertensive retinopathy in a cat

    PubMed Central

    Van Boxtel, Sherry A.

    2003-01-01

    A 12-year-old cat presented for sudden blindness was diagnosed with hypertensive retinopathy on the basis of ophthalmologic and ultrasonic examination. Renal failure due to a large intranephric cyst obstructing the right ureter and renal artery was the suggested cause of the systemic hypertension. The cat died 8 hours after unilateral nephrectomy. PMID:12650046

  2. Microalbuminuria in children with primary and white-coat hypertension.

    PubMed

    Seeman, Tomáš; Pohl, Michael; Palyzova, Daniela; John, Ulrike

    2012-03-01

    Microalbuminuria serves as an early marker of hypertension-related renal damage in adults. However, data on the prevalence of microalbuminuria in paediatric hypertensive patients in general and in children with white-coat hypertension (WCH) specifically are lacking. The aim of our study was to investigate the prevalence of microalbuminuria in children with primary hypertension (PH) and WCH, respectively. This was a retrospective case review of children with PH and WCH treated at three paediatric nephrology centres. Untreated children with either form of hypertension for whom measurements of urinary albumin excretion (UAE) had been performed were enrolled in the study. The study cohort comprised 52 children (39 boys) with hypertension (26 children with PH, 26 with WCH). Microalbuminuria (>3.2 mg/mmol creatinine) was present in 20% of children with PH and none of the children with WCH (p < 0.01). Children with PH had a higher median UAE than those with WCH (1.27 ± 1.92 vs. 0.66 ± 0.46 mg/mmol creatinine, p < 0.05). Based on these results, we suggest that children with PH have an increased prevalence of microalbuminuria, while children with WCH show no signs of hypertension-related renal damage.

  3. Left ventricular systolic function in selected type 1 diabetic patients with or without diabetic retinopathy and microalbuminuria.

    PubMed

    Bućan, Kajo; Bojić, Lovro; Fabijanić, Damir; Galetović, Davor; Čapkun, Vesna; Utrobičić, Dobrila Karlica; Bućan, Ivona

    2014-12-01

    Vascular endothelial dysfunction is a basic etiologic factor for the development of late clinical complications in patients with diabetes mellitus type 1, such as diabetic retinopathy, diabetic nephropathy (which is characterized at the very beginning by microalbuminuria), and left ventricular cardiac dysfunction. The aims of this study were to determine the prevalence of asymptomatic left ventricular systolic dysfunction in patients with diabetes mellitus type 1 and with or without diabetic retinopathy and microalbuminuria, and to correlate the duration of diabetes with the dynamics of diabetic retinopathy, microalbuminuria and asymptomatic left ventricular dysfunction development in these patients. One-hundred and twenty selected patients with diabetes mellitus type 1 were examined by ophthalmologist and cardiologist. All patients underwent ergometric testing and two-dimensional (2-D) echocardiography with pulsed Doppler. Patients were divided into three groups according to their fundus findings and microalbuminuria: (1) patients without diabetic retinopathy and without microalbuminuria (n = 40); (2) patients with diabetic retinopathy without microalbuminuria (n = 40); and (3) patients with diabetic retinopathy and microalbuminuria (n = 40). All three groups of patients with diabetes mellitus type 1 (with low cardiovascular risk, regulated blood sugar, and without diabetic neuropathy) had echocardiographic values in the normal range. We found no statistically significant correlation between the duration of diabetes mellitus type 1 and echocardiographic values.

  4. More Impact of Microalbuminuria on Retinopathy Than Moderately Reduced GFR Among Type 2 Diabetic Patients

    PubMed Central

    Chen, Yu-Hsin; Chen, Harn-Shen; Tarng, Der-Cherng

    2012-01-01

    OBJECTIVE The current study aimed to investigate whether microalbuminuria or moderately decreased glomerular filtration rate (GFR) is a better predictor for the development and progression of retinopathy in type 2 diabetic patients. RESEARCH DESIGN AND METHODS Type 2 diabetic patients without cardiovascular diseases, malignancy, pregnancy, and acute intercurrent illness were enrolled between 1 August 2001 and 31 December 2002. All participants provided their detailed medical history and underwent an eye fundus examination. They were followed up in outpatient clinics, and serum creatinine, urinary albumin-to-creatinine ratio (UACR), and retinal photographs were followed up annually until 31 December 2009. The primary outcomes were development and progression of diabetic retinopathy and nephropathy. The secondary outcomes were cardiovascular events and all-cause mortality. RESULTS Among 487 participants, 81 subjects had normoalbuminuria and moderate renal impairment (baseline eGFR 30–59.9 mL/min/1.73 m2), and 106 subjects had microalbuminuria and baseline eGFR ≥60 mL/min/1.73 m2. Patients with microalbuminuria and eGFR ≥60 mL/min/1.73 m2 had a significantly greater risk for development and progression of diabetic retinopathy (HR 3.34 [95% CI 1.04–10.70]) compared with those with moderate renal impairment and normoalbuminuria after multivariate adjustment. Risks for renal outcome, cardiovascular events, and all-cause mortality were not significantly different between the two groups. CONCLUSIONS Microalbuminuria has a greater impact on predicting the development and progression of diabetic retinopathy compared with moderate decline in GFR among type 2 diabetic patients. PMID:22338100

  5. Microalbuminuria and hypertension in pregnancy: role of aldosterone and inflammation.

    PubMed

    Armanini, Decio; Ambrosini, Guido; Sabbadin, Chiara; Donà, Gabriella; Clari, Giulio; Bordin, Luciana

    2013-09-01

    Women with a history of hypertension in pregnancy are at increased risk of microalbuminuria later in life. Microalbuminuria is a marker of kidney dysfunction frequently related to an inflammatory event. Pregnancy is a dynamic process characterized by immune tolerance, angiogenesis, and hormonal regulation. Menstruation and pregnancy are associated with a physiological inflammation, which is altered in preeclampsia and probably in other hypertensive situations of pregnancy. An imbalance between pro-oxidant factors and the ability to scavenge these factors produces oxidative stress, which has been evaluated in many cells, but leukocytes are the main source of inflammatory cytokines and experimental and clinical evidence support a possible role of aldosterone as a mediator of placental and renal damage mediated by growth factors, reactive oxygen species, and cytokines. Angiotensin-converting enzyme inhibitors and aldosterone receptor blockers are frequently effective in reducing the risk of progression of cardiovascular and renal disease.

  6. Hypertension and microalbuminuria in children with congenital solitary kidneys.

    PubMed

    Schreuder, Michiel F; Langemeijer, Millie E; Bökenkamp, Arend; Delemarre-Van de Waal, Henriette A; Van Wijk, Joanna A E

    2008-06-01

    According to the hyperfiltration hypothesis, a low nephron endowment will lead to hyperfiltration in the remaining glomeruli and is associated with systemic hypertension, proteinuria and glomerulosclerosis. Being born with one functioning kidney instead of two, for instance because of unilateral renal agenesis or multicystic dysplastic kidney, is a cause of congenital renal mass reduction. In order to study the effect of congenital renal mass reduction on renal function and blood pressure, a retrospective chart review of 66 patients at the Pediatric Renal Center of the VU University Medical Center was performed. As intrauterine growth restriction is associated with a low nephron endowment, the additional effect of birthweight was also studied. A total of 50% of patients with congenital renal mass reduction is found to be hypertensive, using anti-hypertensive drugs, and/or having microalbuminuria (>20 mug/min). Patients born small for gestational age have significantly smaller kidneys and lower estimated glomerular filtration rate than patients with a normal birthweight. We conclude that microalbuminuria and/or hypertension is present in 50% of patients with congenital solitary kidneys, which warrants a systematic follow-up of blood pressure, proteinuria and renal function in all patients with congenital solitary functioning kidneys, especially in patients with a low birthweight.

  7. [The diagnosis of hypertension (research on kidney biopsies and microalbuminuria].

    PubMed

    Arabidze, G G; Sokolova, R I; Titov, V N; Tarasov, A V

    1989-01-01

    Patients with essential hypertension, hypertonic glomerulonephritis and Conn's syndrome were examined for excretion of albumin, immunoglobulin G and beta 2-microglobulin. The results obtained were correlated with pathological changes in liver parenchyma according to biopsies withdrawn from the patients. Essential hypertension running a benign course was not characterized by pronounced changes in excretion of the above proteins. Injury to the glomerular apparatus of the kidneys in glomerulonephritis was attended by considerable rise of albumin and immunoglobulin excretion whereas injury to the tubular structures by the increase of beta 2-microglobulin excretion. It is suggested that analysis of microalbuminuria can be used in the differential diagnosis of arterial hypertension running its course in association with the minor urinary syndrome.

  8. Prognostic value of microalbuminuria during antihypertensive treatment in essential hypertension.

    PubMed

    Pascual, Jose Maria; Rodilla, Enrique; Costa, Jose Antonio; Garcia-Escrich, Miguel; Gonzalez, Carmen; Redon, Josep

    2014-12-01

    Whether changes over time of urinary albumin excretion have prognostic value is a matter of discussion. The objective was to assess the prognostic value of changes in urinary albumin excretion over time in cardiovascular risk during antihypertensive treatment. Follow-up study of 2835 hypertensives in the absence of previous cardiovascular disease (mean age 55 years, 47% men, BP 138/80 mm Hg, 19.1% diabetics, and calibrated systemic coronary risk estimation 5 or >10.6%). Usual-care of antihypertensive treatment was implemented to maintain blood pressure<140/90 mm Hg. Urinary albumin excretion was assessed yearly, and the values were expressed as the creatinine ratio. Incidence of cardiovascular events, fatal and nonfatal, was recorded during the follow-up. During a median follow-up of 4.7 years (17 028 patients-year), 294 fatal and first nonfatal cardiovascular events were recorded (1.73 CVD per 100 patients/year). Independently of blood pressure, estimated glomerular filtration rate, level of cardiovascular risk, and antihypertensive treatment, microalbuminuria at baseline and at any time during the follow-up resulted in higher risk for events, hazard ratio (HR) 1.35 (95% confidence interval [CI], 1.08-1.79) and HR 1.49 (95% CI, 1.14-1.94), respectively. Likewise, development of microalbuminuria (HR 1.60; 95% CI, 1.04-2.46) or persistence from the beginning (1.53; 95% CI, 1.13-2.06) had a significantly higher rate of events than if remained normoalbuminuric (HR 1) or regress to normoalbuminuria (HR 1.37; 95% CI, 0.92-2.06) with an 18%, 18%, 8%, and 11% events, respectively, P<0.001. The study supports the value of urinary albumin excretion assessment as a prognostic factor for cardiovascular risk, but also opens the way to consider it as an intermediate objective in hypertension.

  9. Microalbuminuria - A better marker in hypertensive disorders of pregnancy.

    PubMed

    Babu, Ruby P; Christy, Alap; Hegde, Anupama; Manjrekar, Poornima; Joseph, Maria

    2015-09-01

    To assess the role of microalbuminuria in pre-eclampsia (PE) as a diagnostic marker, we studied 40 PE cases and 40 normotensive controls at 24 ± 4 weeks of gestation in women 20-35 years of age. The patients with PE had significant microalbuminuria in comparison with the controls, in addition to deranged renal function tests. The receiver operating characteristic curve showed that microalbuminuria had the highest sensitivity (100%) and good specificity (77.6%). Microalbuminuria had the highest area under the curve (0.869) for both diagnosis of PE and renal function assessment. Microalbuminuria also had a good correlation with systolic blood pressure in the cases with mild grades of renal dysfunction. Microalbuminuria is a specific marker in PE and it also helps to assess the renal function status. Therefore, microalbuminuria may be used in the early diagnosis and management of PE patients in order to reduce the immediate and long-term complications.

  10. Body Mass Index (BMI) Is Associated with Microalbuminuria in Chinese Hypertensive Patients

    PubMed Central

    Liu, Xinyu; Liu, Yu; Chen, Youming; Li, Yongqiang; Shao, Xiaofei; Liang, Yan; Li, Bin; Holthöfer, Harry; Zhang, Guanjing; Zou, Hequn

    2015-01-01

    There is no general consensus on possible factors associated with microalbuminuria in hypertensive patients nor any reported study about this issue in Chinese patients. To examine this issues, 944 hypertensive patients were enrolled in a study based on a cross-sectional survey conducted in Southern China. Multivariate regression analyses were performed to identify the factors related with the presence of microalbuminuria and urinary excretion of albumin. The prevalence of microalbuminuria in hypertensive and non-diabetic hypertensive patients were 17.16% and 15.25%, respectively. Body mass index (BMI), but not waist circumference (WC), were independently associated with microalbuminuria and the values of urinary albumin to creatinine ratio (ACR) based on multiple regression analyses, even after excluding diabetic patients and patients taking inhibitors of the renin-angiotensin system from the analyses. Furthermore, patients with obesity (BMI ≥28) had higher levels of ACR, compared with those with normal weight (BMI <24 kg/m2) and overweight (24 kg/m2≤ BMI < 28). In conclusion, BMI, as a modifiable factor, is closely associated with microalbuminuria among Chinese hypertensive patients, which may provide a basis for future development of intervention approaches for these patients. PMID:25674785

  11. Epicardial Adiposity is Associated with Microalbuminuria in Patients with Essential Hypertension

    PubMed Central

    Ozturk, Mujgan Tek; Ebinç, Fatma Ayerden; Okyay, Gülay Ulusal; Kutlugün, Aysun Akbal

    2017-01-01

    Background Measurement of epicardial adipose tissue (EAT) is suggested as a novel cardiometabolic risk factor. Microalbuminuria is a marker of endothelial dysfunction and is associated with an increased risk for cardiovascular disease in patients with systemic hypertension. The aim of this study was to investigate the relationship of echocardiographic epicardial adipose tissue (EAT) thickness and microalbuminuria in hypertensive patients. Methods 75 essential hypertensive patients were included into the study. All subjects underwent transthoracic echocardiography to measure EAT thickness. Spot urine sample was collected for the assessment of microalbuminuria. Patients were divided into two groups according to their spot urine albumin to creatinine ratio (UACR); Group 1 included normoalbuminuria (0-30 μg/mg); and Group 2: included microalbuminuria (30-300 μg/mg). Thereafter, we evaluated patient characteristics including smoking status, blood pressure, body mass index (BMI), antihypertensive treatment, statin therapy and serum levels of total cholesterol, low-density lipoprotein cholesterol, triglicerides, albumin, C-reactive protein (CRP), creatinine and hemoglobin. Results There was no difference in baseline characteristics between Group 1 and Group 2. Patients with microalbuminuria had significantly higher mean EAT thickness values compared to the normoalbuminuria group (7.1 ± 0.9 vs. 6.6 ± 0.9, p = 0.01). There were positive significant correlations between EAT and age (r = 0.267, p = 0.020), serum creatinine (r = 0.292, p = 0.01), UACR (r = 0.251, p = 0.03), left ventricular mass (r = 0.257, p = 0.03) and left ventricular mass index (r = 0.242, p = 0.04). UACR was independently associated with EAT (p = 0.01) after adjustments were made for age and BMI. Conclusions Epicardial Adipose Tissue (EAT) thickness could be associated with microalbuminuria in patients with essential hypertension. This association could support the recognition of EAT as a credible

  12. Cystatin C, CRP, log TG/HDLc and metabolic syndrome are associated with microalbuminuria in hypertension

    PubMed Central

    Moura, Rafaela do Socorro Souza e Silva; Vasconcelos, Daniel França; Freitas, Eduardo; de Moura, Flavio José Dutra; Rosa, Tânia Torres; Veiga, Joel Paulo Russomano

    2014-01-01

    Background In patients with systemic hypertension, microalbuminuria is a marker of endothelial damage and is associated with an increased risk for cardiovascular disease. Objective To determine the factors that may lead to the occurrence of microalbuminuria in hypertensive patients with serum creatinine lower than 1.5 mg/dL. Methods This cross-sectional study included 133 Brazilians with essential hypertension followed up at a hypertension outpatient clinic. Those with serum creatinine higher than 1.5 mg/dL, as well as those with diabetes mellitus, were excluded. Systolic and diastolic blood pressures were measured, and body mass index (BMI) and GFR estimated by using the CKD-EPI formula were calculated. The serum levels of the following were assessed: CysC, creatinine, total cholesterol, HDL cholesterol, LDL cholesterol, triglycerides, C-reactive protein (CRP) and fasting glucose. Microalbuminuria was determined in 24-hour urine. Hypertensive patients were classified according to the presence of one or more criteria for metabolic syndrome. Results In a multiple regression analysis, the serum levels of CysC and CRP, the atherogenic index log TG/HDLc and the presence of three or more criteria for metabolic syndrome were positively correlated with microalbuminuria (r2: 0.277, p < 0.05). Conclusion CysC, CRP, log TG/HDLc, and the presence of three or more criteria for metabolic syndrome, regardless of serum creatinine, were associated with microalbuminuria, an early marker of kidney damage and cardiovascular risk in patients with essential hypertension. PMID:24162470

  13. Detection of Hypertension Retinopathy Using Deep Learning and Boltzmann Machines

    NASA Astrophysics Data System (ADS)

    Triwijoyo, B. K.; Pradipto, Y. D.

    2017-01-01

    hypertensive retinopathy (HR) in the retina of the eye is disturbance caused by high blood pressure disease, where there is a systemic change of arterial in the blood vessels of the retina. Most heart attacks occur in patients caused by high blood pressure symptoms of undiagnosed. Hypertensive retinopathy Symptoms such as arteriolar narrowing, retinal haemorrhage and cotton wool spots. Based on this reasons, the early diagnosis of the symptoms of hypertensive retinopathy is very urgent to aim the prevention and treatment more accurate. This research aims to develop a system for early detection of hypertension retinopathy stage. The proposed method is to determine the combined features artery and vein diameter ratio (AVR) as well as changes position with Optic Disk (OD) in retinal images to review the classification of hypertensive retinopathy using Deep Neural Networks (DNN) and Boltzmann Machines approach. We choose this approach of because based on previous research DNN models were more accurate in the image pattern recognition, whereas Boltzmann machines selected because It requires speedy iteration in the process of learning neural network. The expected results from this research are designed a prototype system early detection of hypertensive retinopathy stage and analysed the effectiveness and accuracy of the proposed methods.

  14. Hypertension in Pregnancy is a Risk Factor for Microalbuminuria Later in Life

    PubMed Central

    Kattah, Andrea G.; Asad, Reem; Scantlebury, Dawn C.; Bailey, Kent R.; Wiste, Heather J.; Hunt, Steven C.; Mosley, Thomas H.; Kardia, Sharon L.R.; Turner, Stephen T.; Garovic, Vesna D.

    2013-01-01

    We aimed to compare renal function, by estimated GFR, and albuminuria, in three groups of women: nulliparous women, women with a history of normotensive pregnancies, and women with a history of at least one hypertensive pregnancy. Women who participated in the second Family Blood Pressure Program Study visit (2000–2004) and had serum creatinine and urine albumin measurements (n=3015) were categorized as having had no pregnancy lasting greater than 6 months (n=341), having had only normotensive pregnancies (n=2199), or having at least 1 pregnancy with hypertension (n=475) based on a standardized questionnaire. Women who reported having had at least one pregnancy with hypertension were significantly more likely to be hypertensive (75.6% vs. 59.4%, p <0.001), diabetic (34.2% vs. 27.3%, p= < 0.001) and have higher body mass index (32.8 vs. 30.5, p < 0.001) than those who reported normotensive pregnancies. There was a significantly greater risk of microalbuminuria (urine albumin-creatinine ratio greater than 25 mg/g) in those who reported at least one pregnancy with hypertension (OR 1.37, CI 1.02–1.85, p=0.04) than in those with normotensive pregnancies, after adjusting for risk factors for chronic kidney and cardiovascular disease. Hypertension in pregnancy is associated with an increased risk of future microalbuminuria. PMID:24034653

  15. Hypertension in pregnancy is a risk factor for microalbuminuria later in life.

    PubMed

    Kattah, Andrea G; Asad, Reem; Scantlebury, Dawn C; Bailey, Kent R; Wiste, Heather J; Hunt, Steven C; Mosley, Thomas H; Kardia, Sharon L R; Turner, Stephen T; Garovic, Vesna D

    2013-09-01

    The authors aimed to compare renal function by estimated glomerular filtration rate and albuminuria in 3 groups of women: nulliparous women, women with a history of normotensive pregnancies, and women with a history of at least one hypertensive pregnancy. Women who participated in the second Family Blood Pressure Program Study visit (2000-2004) and had serum creatinine and urine albumin measurements (n=3015) were categorized as having had no pregnancy lasting >6 months (n=341), having had only normotensive pregnancies (n=2199), or having had at least 1 pregnancy with hypertension (n=475) based on a standardized questionnaire. Women who reported having had at least one pregnancy with hypertension were significantly more likely to be hypertensive (75.6% vs 59.4%, P<.001), diabetic (34.2% vs 27.3%, P≤.001), and have higher body mass index (32.8 vs 30.5, P<.001) than those who reported normotensive pregnancies. There was a significantly greater risk of microalbuminuria (urine albumin-creatinine ratio >25 mg/g) in those who reported at least one pregnancy with hypertension (odds ratio, 1.37; confidence interval, 1.02-1.85; P=.04) than in those with normotensive pregnancies, after adjusting for risk factors for chronic kidney and cardiovascular disease. Hypertension in pregnancy is associated with an increased risk of future microalbuminuria.

  16. Microalbuminuria is associated with abnormal thoracic aortic mechanics in essential hypertension.

    PubMed

    Tsioufis, C P; Lambrou, S G; Stefanadis, C I; Antoniadis, D I; Kallikazaros, I E; Pitsavos, C E; Toutouzas, P K

    2000-10-01

    In a population of 162 patients with currently untreated essential hypertension, those with microalbuminuria (n = 75) had significantly impaired elastic properties of the proximal ascending thoracic aorta compared with their normoalbuminuric counterparts (n = 87), whereas urinary albumin excretion was a significant predictor of aortic mechanics in the entire population. Impaired aortic mechanics in microalbuminuric hypertensives were not fully accounted for by clustering of classic risk factors for atherosclerosis, and constitute a finding that may entail additional long-term cardiovascular risk in this subgroup of patients.

  17. Microalbuminuria test

    MedlinePlus

    Diabetes - microalbuminuria; Diabetic nephropathy - microalbuminuria; Kidney disease - microalbuminuria; Proteinuria - microalbuminuria ... to have a kidney problem, you can get treatment before the problem gets worse. People with severe ...

  18. New definition of microalbuminuria in hypertensive subjects: association with incident coronary heart disease and death.

    PubMed

    Klausen, Klaus Peder; Scharling, Henrik; Jensen, Gorm; Jensen, Jan Skov

    2005-07-01

    Microalbuminuria has so far been defined as urinary albumin excretion between 20 and 200 microg/min (or 15 to 150 microg/min overnight). In a recent report, an overnight urinary albumin excretion >5 microg/min was strongly predictive of coronary heart disease and death in the general population. The aim of the present study was to confirm this observation in a population of hypertensive individuals. In The Third Copenhagen City Heart Study in 1992 to 1994, 1734 men and women aged 30 to 70 years with hypertension, but no history of coronary heat disease, delivered a timed overnight urine sample. They were followed-up prospectively by registers until 2000 with respect to coronary heart disease, and until 2004 with respect to death. During follow-up, 123 incident cases of coronary heart disease and 308 deaths were traced. Incident coronary heart disease occurred in 11% of subjects with urinary albumin excretion > or =5 microg/min compared with 5% in subjects with urinary albumin excretion <5 microg/min (P<0.001). Similarly, the cumulative mortality was 28% versus 13% (P<0.001). The relative risks of coronary heart disease and death associated with urinary albumin excretion > or =5 microg/min were 2.0 (1.4 to 2.9; P<0.001) and 1.9 (1.5 to 2.3; P<0.001), respectively, after adjustment for age, sex, blood pressure level, antihypertensive drugs, diabetes, creatinine clearance, smoking, lipoproteins, and body mass index. In conclusion, our study supports the new definition of microalbuminuria as urinary albumin excretion >5 microg/min. In future risk assessment in hypertensive individuals, measurement of microalbuminuria has to be included.

  19. Intravitreal bevacizumab in persistent retinopathy secondary to malignant hypertension.

    PubMed

    Salman, Abdelrahman Gaber

    2013-01-01

    To evaluate the efficacy and safety of intravitreal bevacizumab (IVB) injection in persistent retinopathy secondary to malignant hypertension (MHT). Single IVB injection of 1.25 mg/0.05 ml in 12 cases with persistent retinopathy secondary to MHT more than one month after control of MHT with pre and post injection evaluation of best corrected visual acuity (BCVA) and anatomical outcome up to sixth month and postinjection complications were evaluated. Progressive reductions in retinal hemorrhages, exudates, cotton-wool spots, and macular star were documented by photography, angiography, and central macular thickness (CMT) measured by optical coherence tomography (OCT) imaging. Decreased macular edema was the most common finding. Improvement or stabilization of visual acuity was noted in all cases. In addition to proper medical management of MHT, IVB injection is an effective and safe approach to treat persistent retinopathy associated with MHT.

  20. Long-term impact of systolic blood pressure and glycemia on the development of microalbuminuria in essential hypertension.

    PubMed

    Pascual, Jose Maria; Rodilla, Enrique; Gonzalez, Carmen; Pérez-Hoyos, Santiago; Redon, Josep

    2005-06-01

    The objective was to assess the temporal impact of factors related to the development of microalbuminuria during the follow-up of young adult normoalbuminurics with high-normal blood pressure or at stage 1 of essential hypertension. Prospective follow-up was conducted on 245 normoalbuminuric hypertensive subjects (mean age 40.9 years; 134 men; blood pressure 139.7/88.6 mm Hg; body mass index 28.5 kg/m2) never treated previously with antihypertensive drugs, with yearly urinary albumin excretion measurements, until the development of microalbuminuria. After enrollment, patients were placed on usual care including nonpharmacological treatment or with an antihypertensive drug regime to achieve a blood pressure of <135/85 mm Hg. Thirty subjects (12.2%) developed microalbuminuria after a mean follow-up of 29.9 months (range 12 to 144 months), 2.5 per 100 patients per year. Baseline urinary albumin excretion (hazard ratio, 1.07; P=0.006) and systolic blood pressure during the follow-up (hazard ratio, 1.03; P=0.008) were independent factors related to the follow-up urinary albumin excretion in a Cox proportional hazard model. A significant increase in the risk of developing microalbuminuria for urinary albumin excretion at baseline >15 mg per 24-hour systolic blood pressure >139 mm Hg and a positive trend in fasting glucose were observed in the univariate analyses. However, in the multivariate analysis, only the baseline urinary albumin excretion and the trend of fasting glucose were independently related to the risk of developing microalbuminuria. In mild hypertensives, the development of microalbuminuria was linked to insufficient blood pressure control and to a progressive increment of glucose values.

  1. A Microalbuminuria Threshold to Predict the Risk for the Development of Diabetic Retinopathy in Type 2 Diabetes Mellitus Patients

    PubMed Central

    Huang, Yan; Guo, Kaifeng; Lu, Junxi; Zhang, Lei; Yu, Haoyong; Bao, Yuqian; Jia, Weiping

    2012-01-01

    Objective To test the hypothesis that a microalbuminuria (MA) threshold can help predict the risk for the development of diabetic retinopathy (DR) in type 2 diabetes mellitus (T2DM)_ patients. Design We conducted a cross-sectional study of 4739 subjects with T2DM and a prospective study of 297 subjects with T2DM in China respectively. Methods Clinical and laboratory data were collected and biologic risk factors associated with any DR were analysed. Results In the cross-sectional study, we found that MA was an independent risk factor for DR development; further, when the patients were divided into MA deciles, odds ratio (ORs) of DR for the patients in the sixth MA decile (10.7 mg/24 h) was 1.579-fold (1.161–2.147) compared to that for patients in the first MA decile. Furthermore, the OR of DR increased with a gradual increase in MA levels. Similarly, in the prospective study, during a mean follow-up of 4.5 years, we found that 51 patients (29.0%) of the 176 subjects with high MA level (10.7–30 mg/24 h) developed DR, while 17 patients (14.1%) of the 121 subjects with lower MA (<10.7 mg/24 h) developed DR, and the relative risk ratio of the development of DR is 2.13(95% CI, 1.58–3.62, P<0.001). Conclusion These data suggest that an MA threshold can predict the risk for the development of DR in type 2 diabetes mellitus, although it is still within the traditionally established normal range. PMID:22590593

  2. [Microalbuminuria and associated cardiovascular risk factors in patients with arterial systemic hypertension. A subanalysis of the I-Search study].

    PubMed

    Lomelí, Catalina; Rosas-Peralta, Martín; Lorenzo, Antonio; Saucedo, Néstor

    2012-01-01

    To establish the prevalence of microalbuminuria in a group of patients with systemic arterial hypertension (SAH) to analyze the association between this parameter and cardiovascular risk factors as well as with SAH treatment. This is a sub-analysis of 564 patients of Mexico, extracted from an international, observational, and cross-sectional study followed by specialists, The study included patients with SAH without any other causes of microalbuminuria. Microalbuminuria in these patients had a prevalence of 63.8% (95% IC 58.4, 69,3) and correlated with a wide variety of risk factors and concomitant cardiovascular diseases Most patients with microalbuminuria already received treatment with angiotensin II receptor antagonists (50%), without pretending to establish the impact of the drugs on the microalbuminuria values. The prevalence of patients with SAH and high cardiovascular risk is high in this study and justifies their management and care with multifactorial strategies aimed to adequately control their blood pressure and to modify other current cardiovascular risk factors.

  3. Detection of hypertensive retinopathy using vessel measurements and textural features.

    PubMed

    Agurto, Carla; Joshi, Vinayak; Nemeth, Sheila; Soliz, Peter; Barriga, Simon

    2014-01-01

    Features that indicate hypertensive retinopathy have been well described in the medical literature. This paper presents a new system to automatically classify subjects with hypertensive retinopathy (HR) using digital color fundus images. Our method consists of the following steps: 1) normalization and enhancement of the image; 2) determination of regions of interest based on automatic location of the optic disc; 3) segmentation of the retinal vasculature and measurement of vessel width and tortuosity; 4) extraction of color features; 5) classification of vessel segments as arteries or veins; 6) calculation of artery-vein ratios using the six widest (major) vessels for each category; 7) calculation of mean red intensity and saturation values for all arteries; 8) calculation of amplitude-modulation frequency-modulation (AM-FM) features for entire image; and 9) classification of features into HR and non-HR using linear regression. This approach was tested on 74 digital color fundus photographs taken with TOPCON and CANON retinal cameras using leave-one out cross validation. An area under the ROC curve (AUC) of 0.84 was achieved with sensitivity and specificity of 90% and 67%, respectively.

  4. Microalbuminuria in HIV Disease

    PubMed Central

    Hadigan, Colleen; Edwards, Elizabeth; Rosenberg, Alice; Purdy, Julia B.; Fleischman, Estee; Howard, Lilian; Mican, JoAnn M.; Sampath, Karmini; Oyalowo, Akinbowale; Johnson, Antoinette; Adler, Alexandra; Rehm, Catherine; Smith, Margo; Lai, Leon; Kopp, Jeffrey B.

    2013-01-01

    Background/Aims Microalbuminuria is a marker for early kidney disease and cardiovascular risk. The purposes of this study were to determine the prevalence of microalbuminuria in an HIV-infected clinic population, to test the predictive value of a single urine albumin-creatinine ratio (ACR) to identify persistent microalbuminuria and to examine covariates of microalbuminuria. Methods We conducted a prospective cohort study of HIV-infected subjects (n=182) without proteinuria (P/C ratio ≥0.5 g/g), elevated serum creatinine, diabetes, or chronic inflammatory conditions. Subjects completed three research visits within nine months. Microalbuminuria was defined as the geometric mean ACR of 25–355 mg/g for women and 17–250 mg/g for men. Results The prevalence of microalbuminuria was 14%. The negative predictive value of a single urine ACR determination was 98%, whereas the positive predictive value was only 74%. Microalbuminuria was similar among Black (15%) and non-Black (14%) subjects (p=0.8). Subjects with microalbuminuria were more likely to have hypertension (p=0.02) and metabolic syndrome (p=0.03). While duration of HIV infection and the level of HIV viremia were similar between groups, those with microalbuminuria were more likely to have a CD4 count <200 cells/μL (p=0.0003). In a multivariate logistic regression analysis, the only significant independent predictors of microalbuminuria were low CD4 count (p=0.018) and current ritonavir exposure (p=0.04). Conclusion The prevalence of microalbuminuria in an HIV-infected clinic population was similar to earlier reports, and was associated with hypertension and impaired immune function. A single normal ACR determination effectively excludes microalbuminuria, whereas an elevated ACR requires confirmation. PMID:23615312

  5. Grade III or Grade IV Hypertensive Retinopathy with Severely Elevated Blood Pressure

    PubMed Central

    Henderson, Amanda D.; Biousse, Valérie; Newman, Nancy J.; Lamirel, Cédric; Wright, David W.; Bruce, Beau B.

    2012-01-01

    Introduction: Hypertensive retinopathy describes a spectrum of retinal changes in patients with elevated blood pressure (BP). It is unknown why some patients are more likely to develop acute ocular end-organ damage than others with similar BP. We examined risk factors for grade III/IV hypertensive retinopathy among patients with hypertensive urgency in the emergency department (ED) and compared healthcare utilization and mortality between patients with and without grade III/IV hypertensive retinopathy. Methods: A preplanned subanalysis of patients who presented to a university hospital ED with diastolic BP ≥ 120 mmHg and who enrolled in the Fundus Photography versus Ophthalmoscopy Trial Outcomes in the ED study was performed. Bilateral nonmydriatic ocular fundus photographs, vital signs, and demographics were obtained at presentation. Past medical history, laboratory values, healthcare utilization, and mortality were ascertained from medical record review at least 8 months after initial ED visit. Results: Twenty-one patients with diastolic BP ≥ 120 mmHg, 7 of whom (33%) had grade III/IV hypertensive retinopathy, were included. Patients with retinopathy were significantly younger than those without (median 33 vs 50 years, P= 0.02). Mean arterial pressure (165 vs 163 mmHg) was essentially equal in the 2 groups. Patients with retinopathy had substantially increased but nonsignificant rates of ED revisit (57% vs 29%, P = 0.35) and hospital admission after ED discharge (43% vs 14%, P = 0.28). One of the patients with retinopathy died, but none without. Conclusion: Younger patients may be at higher risk for grade III/IV hypertensive retinopathy among patients with hypertensive urgency. Chronic compensatory mechanisms may have not yet developed in these younger patients. Alternatively, older patients with retinopathy may be underrepresented secondary to increased mortality among these patients at a younger age (survivorship bias). Further research is needed to

  6. Malignant hypertension and retinopathy in a western lowland gorilla (Gorilla gorilla gorilla).

    PubMed

    Niemuth, Jennifer N; De Voe, Ryan S; Jennings, Samuel H; Loomis, Michael R; Troan, Brigid V

    2014-08-01

    A 34-year-old western lowland gorilla presented with peracute blindness. Clinical evaluation, diagnostic imaging, laboratory analyses, blood pressure measurements, and necropsy were performed. The clinical and postmortem findings supported malignant hypertension. We describe a case of naturally occurring hypertensive encephalopathy and retinopathy in a gorilla. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  7. Valsartan in combination with lisinopril versus the respective high dose monotherapies in hypertensive patients with microalbuminuria: the VALERIA trial.

    PubMed

    Menne, Jan; Farsang, Csaba; Deák, László; Klebs, Sven; Meier, Matthias; Handrock, Renate; Sieder, Christian; Haller, Hermann

    2008-09-01

    Microalbuminuria is known as an independent predictor for stroke, myocardial infarction, and death. The purpose of the VALERIA trial was a comparison of the efficacy and safety of combination therapy of valsartan and lisinopril with valsartan and lisinopril high-dose monotherapy in patients with hypertension and microalbuminuria. This was a randomized, double-blind, interventional, parallel-group study. After a washout/placebo-run-in phase of 3 weeks, 133 patients were randomized to treatment (1: 1:1) with either lisinopril 40 mg, valsartan 320 mg, or a combination of valsartan/lisinopril 320/20 mg for 30 weeks. At baseline, the urine albumin creatinine ratio was similar for the three treatment groups (geometric means, lisinopril 9.6 mg/mmol, valsartan 9.1 mg/mmol, and valsartan/lisinopril 9.5 mg/mmol). After 30 weeks of treatment, the geometric mean urine albumin creatinine ratio had decreased in all three groups by 41, 51, and 62% to 5.7 mg/mmol (lisinopril), 4.5 mg/mmol (valsartan), and 3.6 mg/mmol (valsartan/lisinopril). The decrease for valsartan/lisinopril was statistically significantly greater compared with lisinopril [adjusted ratio 60%, confidence interval (38-94%), P = 0.029]. Normalization of microalbuminuria was greatest with valsartan and valsartan/lisinopril (lisinopril 17%, valsartan 31%, and valsartan/lisinopril 38% of patients) and was statistically significant for lisinopril in contrast with valsartan/lisinopril (P = 0.034). Differences in blood pressure reduction between the groups were not statistically significant. All treatments were safe and well tolerated. The combination of valsartan and lisinopril provided a significantly better reduction of urine albumin creatinine ratio and more than doubled the rate of patients with normalized urine albumin creatinine ratio compared with lisinopril alone. All treatments were safe and well tolerated.

  8. Risk Factors for Retinopathy and DME in Type 2 Diabetes-Results from the German/Austrian DPV Database.

    PubMed

    Hammes, Hans-Peter; Welp, Reinhard; Kempe, Hans-Peter; Wagner, Christian; Siegel, Erhard; Holl, Reinhard W

    2015-01-01

    To assess the prevalence and risk factors for early and severe diabetic retinopathy and macular edema in a large cohort of patients with type 2 diabetes Retinopathy grading (any retinopathy, severe retinopathy, diabetic macular edema) and risk factors of 64784 were prospectively recorded between January 2000 and March 2013 and analyzed by Kaplan-Meier analysis and logistic regression. Retinopathy was present in 20.12% of subjects, maculopathy was found in 0.77%. HbA1c > 8%, microalbuminuria, hypertension, BMI > 35 kg/m2 and male sex were significantly associated with any retinopathy, while HbA1c and micro- and macroalbuminuria were the strongest risk predictors for severe retinopathy. Presence of macroalbuminuria increased the risk for DME by 177%. Retinopathy remains a significant clinical problem in patients with type 2 diabetes. Metabolic control and blood pressure are relevant factors amenable to treatment. Concomitant kidney disease identifies high risk patients and should be emphasized in interdisciplinary communication.

  9. Investigating kidney donation as a risk factor for hypertension and microalbuminuria: findings from the Swiss prospective follow-up of living kidney donors

    PubMed Central

    Thiel, Gilbert T; Nolte, Christa; Tsinalis, Dimitrios; Steiger, Jürg; Bachmann, Lucas M

    2016-01-01

    Objectives To assess the role of nephrectomy as a risk factor for the development of hypertension and microalbuminuria. Design Prospective, long-term follow-up study. Setting Swiss Organ Living-Donor Health Registry. Participants All living kidney donors in Switzerland between 1993 and 2009. Interventions Data on health status and renal function before 1 year and biennially after donation were collected. Primary and secondary outcome measures Comparison of 1-year and 5-year occurrences of hypertension among normotensive donors with 1-year and 5-year estimates from the Framingham hypertension risk score. Multivariate random intercept models were used to investigate changes of albumin excretion after donation, correcting for repeated measurements and cofactors such as age, male gender and body mass index. Results A total of 1214 donors contributed 3918 data entries with a completed biennial follow-up rate of 74% during a 10-year period. Mean (SD) follow-up of donors was 31.6 months (34.4). Median age at donation was 50.5 years (IQR 42.2–58.8); 806 donors (66.4%) were women. Donation increased the risk of hypertension after 1 year by 3.64 (95% CI 3.52 to 3.76; p<0.001). Those participants remaining normotensive 1 year after donation return to a risk similar to that of the healthy Framingham population. Microalbuminuria before donation was dependent on donor age but not on the presence of hypertension. After nephrectomy, hypertension became the main driver for changes in albumin excretion (OR 1.19; 95% CI 0.13 to 2.25; p=0.03) and donor age had no effect. Conclusions Nephrectomy propagates hypertension and increases susceptibility for the development of hypertension-induced microalbuminuria. PMID:27006347

  10. Influence of microalbuminuria on left ventricular geometry and function in hypertensive patients with type 2 diabetes mellitus.

    PubMed

    Picca, Maurizio; Agozzino, Francesco; Pelosi, Giancarlo

    2003-01-01

    An increased urinary albumin excretion (UAE) is associated with an augmented risk of cardiovascular disease in diabetic patients and in non-diabetic subjects. Left ventricular hypertrophy has been demonstrated to be a powerful predictor of cardiovascular morbidity and mortality in arterial hypertension and when the ventricular geometry is concentric the relation is even stronger. This echocardiographic and Doppler study was designed to evaluate the influence of microalbuminuria on the left ventricular geometry and function in hypertensive patients with type 2 diabetes melitus. Forty-two patients (16 males, 26 females, mean age 59.6 +/- 6.7 years) with mild-to-moderate essential hypertension and type 2 diabetes mellitus were enrolled in the study. Twenty-one patients had an elevated UAE (group 1) and 21 a normal UAE (group 2). M-mode (under two-dimensional control) and Doppler echocardiography were performed after a 4-week washout period off antihypertensive therapy. The left ventricular mass index was found to be greater than the partition value of 51 g/m2.7 in both groups but was significantly higher (p < 0.001) in group 1. The midwall fractional shortening was significantly lower (p < 0.001) in group 1 in comparison with group 2. The E/A ratio was impaired in both groups but was more significantly reduced (p < 0.02) in group 1. There was a significantly higher prevalence of a left ventricular concentric hypertrophy pattern (19/21 patients, p < 0.001) in group 1. In hypertensive patients with type 2 diabetes mellitus, an elevated UAE is associated with an increased left ventricular mass index, a higher prevalence of a concentric left ventricular hypertrophy pattern, a depressed midwall systolic performance and a markedly impaired diastolic function...

  11. Malignant Hypertensive Retinopathy in an Infant with Mid-Aortic Occlusion

    PubMed Central

    Bhardwaj, Gaurav; Winlaw, David S.; Donaldson, Craig E.

    2016-01-01

    Purpose. Case report describing an eight-month-old infant presenting with intermittent esotropia and irritability who was found to have malignant (grade 4) hypertensive retinopathy and mid-aortic syndrome. Methods. Visual acuity was 6/140 in the right eye and not recordable in the left eye. Blood pressure was as high as 230/120 mmHg. Fundoscopy revealed bilateral optic disc swelling, macular stars, and serous retinal detachment in the left eye, findings that are consistent with malignant (grade 4) hypertensive retinopathy. CT abdominal angiogram revealed a severe mid-aortic syndrome with occlusion of the abdominal aorta at T12. Results. The patient was treated with medical management of his hypertension, improving the subretinal exudate. Binocular visual acuity improved to 6/9.5 over 9 months. There was a persistent left relative afferent pupillary defect and moderate left esotropia. Conclusion. This is the first reported case of malignant hypertensive retinopathy in an infant with concomitant mid-aortic occlusion. The authors emphasize the need for an ophthalmological and pediatric examination in a child presenting with intermittent squint and irritability. The esotropia was found to be a false localizing sign of raised intracranial pressure secondary to the severe mid-aortic syndrome. PMID:27795862

  12. Subclinical Kidney Damage in Hypertensive Patients: A Renal Window Opened on the Cardiovascular System. Focus on Microalbuminuria.

    PubMed

    Mulè, Giuseppe; Castiglia, Antonella; Cusumano, Claudia; Scaduto, Emilia; Geraci, Giulio; Altieri, Dario; Di Natale, Epifanio; Cacciatore, Onofrio; Cerasola, Giovanni; Cottone, Santina

    2017-01-01

    presence of microalbuminuria (MAU), that is an amount of albumin in the urine of 30-300 mg/day or an albumin/creatinine ratio, preferentially on morning spot urine, of 30-300 mg/g.There is clear evidence that urinary albumin excretion levels, even below the cut-off values used to define MAU, are associated with an increased risk of CV events. The relationships of MAU with a variety of risk factors, such as blood pressure, diabetes and metabolic syndrome and with several indices of subclinical organ damage, may contribute, at least in part, to explain the enhanced CV risk conferred by MAU. Nonetheless, several studies showed that the association between MAU and CV disease remains when all these risk factors are taken into account in multivariate analyses. Therefore, the exact pathophysiological mechanisms explaining the association between MAU and CV risk remain to be elucidated. The simple search for MAU and in general of subclinical renal involvement in hypertensive patients may enable the clinician to better assess absolute CV risk, and its identification may induce physicians to encourage patients to make healthy lifestyle changes and perhaps would prompt to more aggressive modification of standard CV risk factors.

  13. Combination therapy with aliskiren versus ramipril or losartan added to conventional therapy in patients with type 2 diabetes mellitus, uncontrolled hypertension and microalbuminuria.

    PubMed

    Imbalzano, Egidio; Scarpelli, Mirko; Mandraffino, Giuseppe; Creazzo, Michele; Lizio, Giuseppina; Trapani, Giovanni; Dattilo, Giuseppe; Dalbeni, Andrea; Tomasello, Carmelo; Sardo, Maria Adriana; Saitta, Antonino

    2015-12-01

    The aim of this study was to assess the antihypertensive efficacy and safety of aliskiren versus ramipril or losartan in hypertensive patients with type 2 diabetes mellitus, microalbuminuria and uncontrolled hypertension, despite the use of optimal conventional antihypertensive therapy. In this open-label active comparator study, 126 patients were randomly assigned to receive 24 weeks of additional therapy with aliskiren (Group A) or either losartan or ramipril (Group B), according to whether a patient was already treated with an angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker, respectively. After 24 weeks, both treatment groups experienced a significant reduction of systolic blood pressure (-11.37% and -8.47%, respectively; both p <0.001 vs. baseline) and diastolic blood pressure levels (-10.67% and -9.28%, respectively; both p <0.001 vs. baseline), with a greater reduction of mean systolic values in Group A compared with Group B (p <0.001). Furthermore, after six months microalbuminuria was significantly decreased in both treatment groups (-67.62% and -49.1%, respectively; both p <0.001), with a reduction rate in Group A significantly higher than in Group B (p<0.001). The addition of aliskiren to optimal conventional therapy provided a higher reduction of blood pressure and urinary albumin excretion when compared with the addition of losartan or ramipril. © The Author(s) 2014.

  14. Hypertensive Retinopathy Associated With Use of the Ephedra-Free Weight-Loss Herbal Supplement Hydroxycut

    PubMed Central

    Willis, Scott L.; Moawad, Fouad J.; Hartzel, Joshua D.; Iglesias, Melissa; Jackson, William L.

    2006-01-01

    The use of performance-enhancing and weight-loss supplements is prevalent in the United States, and over the past decade, there has been growing concern with regard to the safety and efficacy of these products. It is well documented that ephedra-based products are associated with adverse reactions, including serious cardiovascular and neurologic injuries. With new restrictions placed on such products, companies are now marketing caffeine-based ephedra-free herbal supplements. Less is known about the potential side effects of these products. We present the case of a 42-year-old, previously healthy man who developed malignant hypertension and hypertensive retinopathy while taking Hydroxycut, a caffeine-based ephedra-free supplement. To our knowledge, this is the first documented case of hypertensive retinopathy associated with the use of Hydroxycut. Given the lack of investigative studies in regard to their safety and efficacy, judicious care should be taken with the use of all herbal supplements, including those designated as ephedra-free. Readers are encouraged to respond to George Lundberg, MD, Editor of MedGenMed, for the editor's eye only or for possible publication via email: glundberg@medscape.net PMID:17406200

  15. Randomised controlled trial of dual blockade of renin-angiotensin system in patients with hypertension, microalbuminuria, and non-insulin dependent diabetes: the candesartan and lisinopril microalbuminuria (CALM) study

    PubMed Central

    Mogensen, Carl Erik; Neldam, Steen; Tikkanen, Ilkka; Oren, Shmuel; Viskoper, Reuven; Watts, Richard W; Cooper, Mark E

    2000-01-01

    Objectives To assess and compare the effects of candesartan or lisinopril, or both, on blood pressure and urinary albumin excretion in patients with microalbuminuria, hypertension, and type 2 diabetes. Design Prospective, randomised, parallel group, double blind study with four week placebo run in period and 12 weeks' monotherapy with candesartan or lisinopril followed by 12 weeks' monotherapy or combination treatment. Setting Tertiary hospitals and primary care centres in four countries (37 centres). Participants 199 patients aged 30-75 years. Interventions Candesartan 16 mg once daily, lisinopril 20 mg once daily. Main outcome measures Blood pressure and urinary albumin:creatinine ratio. Results At 12 weeks mean (95% confidence interval) reductions in diastolic blood pressure were 9.5 mm Hg (7.7 mm Hg to 11.2 mm Hg, P<0.001) and 9.7 mm Hg (7.9 mm Hg to 11.5 mm Hg, P<0.001), respectively, and in urinary albumin:creatinine ratio were 30% (15% to 42%, P<0.001) and 46% (35% to 56%, P<0.001) for candesartan and lisinopril, respectively. At 24 weeks the mean reduction in diastolic blood pressure with combination treatment (16.3 mm Hg, 13.6 mm Hg to 18.9 mm Hg, P<0.001) was significantly greater than that with candesartan (10.4 mm Hg, 7.7 mm Hg to 13.1 mm Hg, P<0.001) or lisinopril (mean 10.7 mm Hg, 8.0 mm Hg to 13.5 mm Hg, P<0.001). Furthermore, the reduction in urinary albumin:creatinine ratio with combination treatment (50%, 36% to 61%, P<0.001) was greater than with candesartan (24%, 0% to 43%, P=0.05) and lisinopril (39%, 20% to 54%, P<0.001). All treatments were generally well tolerated. Conclusion Candesartan 16 mg once daily is as effective as lisinopril 20 mg once daily in reducing blood pressure and microalbuminuria in hypertensive patients with type 2 diabetes. Combination treatment is well tolerated and more effective in reducing blood pressure. PMID:11110735

  16. Effect of lercanidipine compared with ramipril on albumin excretion rate in hypertensive Type 2 diabetic patients with microalbuminuria: DIAL study (diabete, ipertensione, albuminuria, lercanidipina).

    PubMed

    Dalla Vestra, M; Pozza, G; Mosca, A; Grazioli, V; Lapolla, A; Fioretto, P; Crepaldi, G

    2004-10-01

    Microalbuminuria and hypertension are risk factors for diabetic nephropathy in Type 2 diabetic patients. Recent data suggest that blockade of the renin-angiotensin system slows the progression of diabetic nephropathy; in contrast, the results on the renoprotective effect of calcium channel antagonists are conflicting. We evaluated the effectiveness of lercanidipine, in comparison with ramipril, on the reduction in albumin excretion rate (AER) and blood pressure in mild-to-moderate hypertensive patients with Type 2 diabetes and persistent microalbuminuria. A total of 277 patients were enrolled in a multicentric, randomized, double-blind, active-controlled, parallel-group trial; 180 were randomized to receive 10-20 mg/day of lercanidipine or 5-10 mg/day of ramipril and followed up for 9-12 months. The primary outcome was the change in AER from baseline. After 9-12 months of follow-up, a reduction in AER of -17.4+/-65 microg/min (p<0.05) and -19.7+/-52.5 (p<0.05) in the lercanidipine and ramipril group, respectively, was observed, without differences between the groups. A significant reduction in systolic and diastolic blood pressure was observed in both the lercanidipine and ramipril-based treatment groups (p<0.0001 for both). This study demonstrated that treatment with lercanidipine 10-20 mg/day does not worsen albuminuria in microalbuminuric Type 2 diabetic patients with hypertension. Indeed, both lercanidipine and ramipril treatments resulted in a significant reduction in AER without a statistically significant difference between the two groups.

  17. Hypertensive Retinopathy as the First Manifestation of Advanced Renal Disease in a Young Patient: Report of a Case

    PubMed Central

    Arriozola-Rodríguez, Karen Janeth; Serna-Ojeda, Juan Carlos; Martínez-Hernández, Virginia Alejandra; Rodríguez-Loaiza, José Luis

    2015-01-01

    The purpose of this paper was to report the case of a 23-year-old patient suffering from bilateral acute visual loss who received the diagnosis of hypertensive retinopathy. After systemic evaluation, he was diagnosed with bilateral renal disease and chronic renal failure, requiring a kidney transplantation to manage the systemic illness, followed by gradual improvement of his visual acuity. PMID:26955342

  18. Renal and cardiovascular risk predictive value of two different microalbuminuria screening methods in patients with hypertension with/without diabetes in Portugal.

    PubMed

    Polónia, J; Carvalho, D; Nazaré, J; Martins, L; da Silva, P M; Aguiar, C; Manso, M C; Carqueja, T

    2016-11-01

    MicRoAlbuminuria sCreening survEy (RACE) was a multicentre, observational, cross-sectional study conducted in primary health-care settings of Portugal. Here, we present a post-hoc analysis from the RACE study, assessing the renal and cardiovascular (CV) risk predictive value of two different microalbuminuria (MA) screening methods, nephelometry with 24-h urine (MA-24 h) and Micral test with occasional urine (MicralA) in patients with hypertension (HTN) with/without type 2 diabetes mellitus (T2DM). Out of 3065 patients, 1173 (38.3%) were in the HTN group without T2DM (HTN) and 1892 (61.7%) in the HTN group with T2DM (HTN+T2DM). The overall prevalence of MA was 50.6% determined by MicralA and 22.1% with MA-24 h. Urinary albumin excretion data obtained by both techniques correlated significantly (rs=0.586; P<0.001). In all subjects, MicralA showed a sensitivity of 93%, specificity of 62% for detection of MA, with a positive predictive value of 41% and negative predictive value of 97%. With both methods, the presence of MA was independently associated with a higher risk (1.5- to 2.9-fold) of CV and renal organ damage in both HTN and HTN+T2DM groups. MicralA, due to its high sensitivity and negative predictive value, can be considered as a valid and reliable method for MA screening in patients with HTN with/without T2DM.

  19. Prevalence of microalbuminuria among secondary school children.

    PubMed

    Okpere, A N; Anochie, I C; Eke, F U

    2012-06-01

    Microalbuminuria is an early sign of kidney and cardiovascular damage. Therefore, early detection in asymptomatic individuals may be helpful in preventing deterioration in renal function. We carried out a cross-sectional study of 820 secondary school students aged 10 - 19 years from September to November 2008. The urine samples of 615 (75.0%) without overt proteinuria and haematuria were tested for microalbuminuria using the micral test strips. Values of greater than 20mg/L were considered positive. There were 299 (48.6%) males and 316 (51.4%) females, with a M:F ratio of 1:1.1. The prevalence of microalbuminuria as seen in 214 of the students was 33.2%. It was significantly higher in females (45.3%), obese subjects (35.4%), those with hypertension (70.6%), those with positive family history of hypertension (59.5%), and diabetes mellitus (46.4%). Microalbuminuria was found in 1 of the 2 subjects who had features of DM and in one subject with sickle cell anemia. The prevalence of microalbuminuria in Nigerian adolescents is high. We recommend routine screening for microalbuminuria in adolescents for early detection and prevention of renal damage.

  20. Hypertensive retinopathy and cerebral small vessel disease in Amerindians living in rural Ecuador: The Atahualpa Project.

    PubMed

    Del Brutto, Oscar H; Mera, Robertino M; Viteri, Eduardo M; Pólit, Joaquín; Ledesma, Ernesto A; Cano, José A; Plaza, Karin J; Zambrano, Mauricio; Costa, Aldo F

    2016-09-01

    Diagnosis of cerebral small vessel disease (SVD) is a challenge in remote areas where MRI is not available. Hypertensive retinopathy (HTRP) has shown to correlate with SVD in different ethnic groups, but there is no information from indigenous Latin American people. We assessed the usefulness of retinal photographs to detect cases with SVD among Amerindians living in rural Ecuador. Atahualpa residents aged ≥60years with arterial hypertension or prehypertension were identified during a door-to-door survey. A confocal line scanning laser ophthalmoscope was used to identify and grade HTRP (according to the Keith-Wagener-Barker classification). MRIs were read with attention to the presence of white matter hyperintensities (WMH) of presumed vascular origin and lacunar infarcts. Using logistic regression models, we evaluated whether HTRP was independently associated with neuroimaging signatures of SVD. Of 323 eligible candidates, 241 (75%) were enrolled. MRI readings revealed moderate-to-severe WMH in 49 (20%) cases and lacunar infarcts in 29 (12%). HTRP Grade 1 was noticed in 90 (37%) individuals and Grade 2-3 in 42 (17%). After adjusting for demographics and cardiovascular risk factors, multivariate analyses showed a significant association between Grades 2-3 HTRP and moderate-to-severe WMH (OR: 3.87, 95% C.I.: 1.64-9.13) but not with lacunar infarcts (OR: 2.22, 95% C.I.: 0.83-5.92). Amerindians with HTRP Grades 2-3 are almost four times more likely to have SVD-related subcortical damage than those with no- or only Grade 1-HTRP. Retinal photographs might allow recognition of people who need further investigation and therapy. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  1. Microalbuminuria is associated with limited joint mobility in type I diabetes mellitus.

    PubMed Central

    Montaña, E; Rozadilla, A; Nolla, J M; Gomez, N; Escofet, D R; Soler, J

    1995-01-01

    OBJECTIVE--To determine whether limited joint mobility (LJM) is associated with microalbuminuria in type I diabetes mellitus. METHODS--Joint mobility was measured in a control group of 63 healthy subjects and in 63 type I diabetic patients, older than 18 years (mean 31.7 years, range 18-57), recruited from the outpatient clinic of the Endocrine Unit. Patients with established diabetic nephropathy (proteinuria or increased creatinine) were excluded. Joint mobility was assessed qualitatively with the prayer manoeuvre and quantitatively by measuring the angles of maximal flexion and extension of the fifth and third metacarpophalangeal (MCP) joints and wrist. Diabetic retinopathy was assessed by direct ophthalmoscopy. Urinary albumin excretion (UAE) was determined in at least two 24 hour urine samples. RESULTS--Joint mobility was limited in diabetic patients compared with control subjects. Diabetic patients with LJM had longer duration of diabetes (12.1 (SD 6.4) years compared with 6.9 (5.7) years; p < 0.001). Joint mobility was limited in patients with retinopathy: prayer manoeuvre was positive in 96.4% of patients with retinopathy, but in only 40.0% of patients with no retinopathy (p < 0.001); mobility of MCP joints and wrist was limited in diabetic patients with retinopathy even when the longer duration of their diabetes was taken into consideration. Microalbuminuria, present in 11 patients (17.5%), was associated with LJM: prayer manoeuvre was positive in 90.9% of patients with microalbuminuria, but in only 57.4% of patients with normal UAE (p < 0.05). Maximal flexion of MCP joints was reduced in patients with microalbuminuria. Microalbuminuria, but not LJM, was associated with risk factors of cardiovascular disease. CONCLUSION--LJM is associated with microalbuminuria and retinopathy in type I diabetes. The association is independent of age and duration of diabetes. PMID:7668902

  2. Four-Year Incidence of Diabetic Retinopathy in a Spanish Cohort: The MADIABETES Study

    PubMed Central

    Salinero-Fort, Miguel Á.; San Andrés-Rebollo, Francisco Javier; de Burgos-Lunar, Carmen; Arrieta-Blanco, Francisco Jesús; Gómez-Campelo, Paloma

    2013-01-01

    Objective To evaluate the incidence of diabetic retinopathy in patients with Type 2 Diabetes Mellitus, to identify the risk factors associated with the incidence of retinopathy and to develop a risk table to predict four-year retinopathy risk stratification for clinical use, from a four-year cohort study. Design The MADIABETES Study is a prospective cohort study of 3,443 outpatients with Type 2 Diabetes Mellitus, sampled from 56 primary health care centers (131 general practitioners) in Madrid (Spain). Results The cumulative incidence of retinopathy at four-year follow-up was 8.07% (95% CI = 7.04–9.22) and the incidence density was 2.03 (95% CI = 1.75–2.33) cases per 1000 patient-months or 2.43 (95% CI = 2.10–2.80) cases per 100 patient-years. The highest adjusted hazard ratios of associated risk factors for incidence of diabetic retinopathy were LDL-C >190 mg/dl (HR = 7.91; 95% CI = 3.39–18.47), duration of diabetes longer than 22 years (HR = 2.00; 95% CI = 1.18–3.39), HbA1c>8% (HR = 1.90; 95% CI = 1.30–2.77), and aspirin use (HR = 1.65; 95% CI = 1.22–2.24). Microalbuminuria (HR = 1.17; 95% CI = 0.75–1.82) and being female (HR = 1.12; 95% CI = 0.84–1.49) showed a non-significant increase of diabetic retinopathy. The greatest risk is observed in females who had diabetes for more than 22 years, with microalbuminuria, HbA1c>8%, hypertension, LDL-Cholesterol >190 mg/dl and aspirin use. Conclusions After a four-year follow-up, the cumulative incidence of retinopathy was relatively low in comparison with other studies. Higher baseline HbA1c, aspirin use, higher LDL-Cholesterol levels, and longer duration of diabetes were the only statistically significant risk factors found for diabetic retinopathy incidence. This is the first study to demonstrate an association between aspirin use and diabetic retinopathy risk in a well-defined cohort of patients with Type 2 Diabetes Mellitus at low risk of

  3. Fenofibrate and Diabetic Retinopathy.

    PubMed

    Knickelbein, Jared E; Abbott, Akshar B; Chew, Emily Y

    2016-10-01

    Diabetic retinopathy, a common and sight-threatening microvascular complication of diabetes mellitus, is a leading cause of blindness among working-aged adults. Medical therapies including intensive control of hyperglycemia and hypertension have been shown to reduce the incidence and progression of diabetic retinopathy. The association of dyslipidemia and treatment with statins with diabetic retinopathy is inconsistent in epidemiologic studies. However, two recent randomized clinical trials have demonstrated beneficial effects of systemic fenofibrate therapy in reducing the progression of diabetic retinopathy independently of serum lipid levels. These findings suggest that fenofibrate may be an effective strategy for reducing the progression of diabetic retinopathy, thus reducing the large and growing public health burden of treating the sight-threatening complications of diabetic retinopathy.

  4. Microalbuminuria and its Association with Subclinical Atherosclerosis in the Mexican Mestizo population: the GEA study.

    PubMed

    Medina-Urrutia, Aida; Juárez-Rojas, Juan Gabriel; Posadas-Sánchez, Rosalinda; Jorge-Galarza, Esteban; Cardoso-Saldaña, Guillermo; Vargas-Alarcón, Gilberto; Martínez-Alvarado, Rocío; Posadas-Romero, Carlos

    2016-01-01

    Microalbuminuria is an early marker of atherosclerosis. Ethnic differences for both conditions have been reported. We studied microalbuminuria prevalence and its association with coronary artery calcification as an early atherosclerosis marker in a Mexican-Mestizo population free of diabetes and hypertension (healthy), as well as in hypertensive and diabetic subjects. In 1,472 adults (53.3 ± 9.4 years old, 50.3% women), anthropometric measurements, fasting blood glucose, and lipid profile were determined. A spot urine sample was used to quantify the albumin-to-creatinine ratio and to define microalbuminuria (20-200 mg/g in men, and 30-300 mg/g in women). A coronary artery calcification score was obtained by electron-beam computed tomography and subclinical atherosclerosis was defined as a score > 0. Overall microalbuminuria prevalence was 9.3% (5.4% in healthy, 11.6% in obese, 12% in hypertensive, and 25% in diabetic subjects). Compared to "healthy" subjects without microalbuminuria, those with microalbuminuria had a ∼3-fold higher prevalence of coronary artery calcification > 0, while normal-high albumin-to-creatinine ratio (OR: 1.8; p < 0.05) and microalbuminuria (OR: 2.6; p < 0.001) was independently associated with coronary artery calcification > 0 only among diabetic subjects. Microalbuminuria and high-normal albumin-to-creatinine ratio were independently associated with subclinical atherosclerosis, suggesting that they may confer a higher risk of future cardiovascular events.

  5. Diabetic Retinopathy

    MedlinePlus

    ... version of this page please turn Javascript on. Diabetic Retinopathy What Is Diabetic Retinopathy? Click for more information Can Cause Vision ... vision loss and even blindness can result. Other Diabetic Eye Diseases In addition to diabetic retinopathy, other ...

  6. GEMCITABINE-INDUCED RETINOPATHY.

    PubMed

    Kovach, Jaclyn L

    2016-10-31

    To report a case of Purtscher-like retinopathy associated with gemcitabine. The author reports a 68-year-old woman who presented with a 4-month history of bilateral vision loss. She had a history of diabetes, hypertension, and leiomyosarcoma, diagnosed 5 months before presentation and had completed 5 cycles of combination treatment with gemcitabine and docetaxel. Clinical examination revealed a Purtscher-like retinopathy that improved after gemcitabine cessation without the development of cystoid macular edema or retinal neovascularization. This case highlights the importance of recognizing gemcitabine-induced ischemic retinopathy that can be associated with life-threatening myocardial or renal ischemia.

  7. Diabetic retinopathy.

    PubMed

    Moreno, A; Lozano, M; Salinas, P

    2013-03-01

    This paper describes the importance of diabetic retinopathy in the loss of visual function. We exposed the most important risk factors, such as diabetes duration, poor metabolic control, pregnancy, puberty, hypertension, poor control of blood lipids, renal disease, and sleep apnea syndrome. We describe the pathogenesis of the disease, small retinal vessel microangiopathies which produce extravasation, edema and ischemia phenomena. We put special emphasis on the vascular endothelial growth factor (VEGF) and its pathogenic importance. They are also described the main clinical symptoms as microaneurysms, intraretinal hemorrhages, hard and soft exudates, intraretinal microvascular abnormalities (IRMA), venous disorders, formation of new vessels and diabetic macular edema (the latter being the most common cause of vision loss). Finally we describe the latest diagnostic techniques and eye treatment, with special emphasis on obesity surgery importance as more important preventive factor to eliminate the predisposing and precipitating disease symptoms.

  8. Prevalence of microalbuminuria among middle-aged population of China: a multiple center cardiovascular epidemiological study.

    PubMed

    Hao, Guang; Wang, ZengWu; Zhang, Linfeng; Chen, Zuo; Wang, Xin; Guo, Min; Tian, Ye; Shao, Lan; Zhu, Manlu

    2015-01-01

    We assessed the prevalence of microalbuminuria (MAU) and the relationships with other cardiovascular (CV) risk factors among a middle-aged Chinese population. Data from 10 313 participants were included in our cross-sectional survey. Microalbuminuria was defined as the urine albumin to creatinine ratio of 30:300 mg/g from a single-spot morning urine sample. Microalbuminuria was found to be common in males and females (15.04% vs 10.09%) aged 35 to 64 years in this Chinese general population, especially in those with obesity, hypertension, and diabetes. Multivariate analysis found that body mass index, triglyceride, high-sensitivity C-reactive protein, alcohol consumption, hypertension, and diabetes were independently associated with MAU. Microalbuminuria may be a useful indicator for risk of CV disease in general populations.

  9. Occurrence of microalbuminuria among children and adolescents with insulin-dependent diabetes mellitus.

    PubMed

    Al-Agha, Abdulmoein E; Ocheltree, Ali; Hakeem, Amr

    2013-11-01

    Microalbuminuria precedes the onset of diabetic nephropathy in insulin-dependent diabetes mellitus (IDDM) pediatric patients. Its prevention is among the most important challenges in managing IDDM. We attempted to determine the occurrence of microalbuminuria among IDDM Saudi children and adolescents and its associated risk factors. This is a retrospective cross-sectional study conducted on 409 IDDM children and adolescents attending the pediatric clinic at King Abdul-Aziz University Hospital from 2006 to 2010. Their ages ranged from 1 to 18 years and the mean ± standard deviation (mean ± SD) was 12.3 ± 4.1 years. Twenty-four-hour urinary albumin excretion (on two separate occasions or more, 3 - 6 months apart each), HbA1c, duration of IDDM, Tanner staging and body mass index (BMI) were reviewed. Prevalence of microalbuminuria in our cohort was 11.3%. IDDM duration was ≥2 years in 55.8% of our patients; of them, 15.6% had microalbuminuria while 45.2% had IDDM duration <2 years (6% had microalbuminuria) (P <0.01). The prevalence of microalbuminuria was higher among the post-pubertal subjects (50%) than that among the pre-pubertal (8.7%) and pubertal (41.5%) subjects. Furthermore, microalbuminuria was present in 16.7% of those with elevated blood pressure, but only in 8.5% among those with normal blood pressure (P <0.05). The enrolled overweight and obese subjects showed a higher prevalence of microalbuminuria (14%) when compared with that among those with a normal BMI (6.6%) (P <0.05). In our cohort, duration of IDDM, pubertal status, hypertension and BMI affected the prevalence of microalbuminuria. Annual screening for microalbuminuria in IDDM children and adolescents is imperative.

  10. [Microalbuminuria in pediatric patients diagnosed with hemolytic uremic syndrome].

    PubMed

    Cubillos C, María Paz; Del Salas, Paulina; Zambrano, Pedro O

    2015-01-01

    Hemolytic uremic syndrome (HUS) is characterized by the presence of microangiopathic hemolytic anemia, thrombocytopenia, and acute kidney failure. It is the leading cause of acute kidney failure in children under 3 years of age. A variable number of patients develop proteinuria, hypertension, and chronic renal failure. To evaluate the renal involvement in pediatric patients diagnosed with HUS using the microalbumin/creatinine ratio. Descriptive concurrent cohort study that analyzed the presence of microalbuminuria in patients diagnosed with HUS between January 2001 and March 2012, who evolved without hypertension and normal renal function (clearance greater than 90ml/min using Schwartz formula). Demographic factors (age, sex), clinical presentation at time of diagnosis, use of antibiotics prior to admission, and need for renal replacement therapy were evaluated. Of the 24 patients studied, 54% were male. The mean age at diagnosis was two years. Peritoneal dialysis was required in 45%, and 33% developed persistent microalbuminuria. Antiproteinuric treatment was introduce in 4 patients, with good response. The mean follow-up was 6 years (range 6 months to 11 years). The serum creatinine returned to normal in all patients during follow up. The percentage of persistent microalbuminuria found in patients with a previous diagnosis of HUS was similar in our group to that described in the literature. Antiproteinuric treatment could delay kidney damage, but further multicenter prospective studies are necessary. Copyright © 2015. Publicado por Elsevier España, S.L.U.

  11. [Eclipse retinopathy].

    PubMed

    Johannessen, Simon; Høgsbro, Malou

    2014-11-10

    Eclipse retinopathy is a condition with macular damage resulting from viewing of a solar eclipse. This case report illustrates how eclipse retinopathy was diagnosed with a delay of more than 30 years. The report also summarises how solar eclipse can be observed without risk of retinal damage.

  12. Radiation retinopathy.

    PubMed Central

    Zamber, R W; Kinyoun, J L

    1992-01-01

    Radiation therapy is effective against many cancerous and noncancerous disease processes. As with other therapeutics, side effects must be anticipated, recognized, and managed appropriately. Radiation retinopathy is a vision-threatening complication of ocular, orbital, periorbital, facial, nasopharyngeal, and cranial irradiation. Factors that appear important in the pathogenesis of radiation retinopathy include total radiation dosage, fraction size, concomitant chemotherapy, and preexisting vascular disorders. Clinical manifestations of the disorder include macular edema and nonproliferative and proliferative retinopathy, similar to changes seen in diabetic retinopathy. Argon laser photocoagulation has proved efficacious for managing macular edema and fibrovascular proliferation in some of these patients. Ongoing basic laboratory and clinical research efforts have led to a better understanding of the pathogenesis, natural history, and treatment response of radiation retinopathy. The ultimate goal of this knowledge is to improve the prevention, recognition, and management of this vision-threatening complication. Images PMID:1441494

  13. Serum ICAM-1 level and ICAM-1 gene 1462A>G (K469E) polimorphism on microalbuminuria in nondiabetic, nonhypertensive and normolipidemic obese patients: Genetical background of microalbuminuria in obesity.

    PubMed

    Atay, Ahmet Engin; Esen, Bennur; Akbas, Halit; Gokmen, Emel Saglam; Pilten, Saadet; Guler, Hale; Yavuz, Dilek Gogas

    A growing body of evidence suggest that obese individuals are under risk of renal parenchymal disorders when compared to nonobese counterparts. Microalbuminuria is the early marker of renal involvement. Although most of obese patients carries multiple risk factors for microalbuminuria, some obese individuals without risk factor may progress to microalbuminuria. The present study was performed to examine the role of ICAM-1 gene 1462A>G (K469E) polymorphism on microalbuminuria in obese subjects without diabetes mellitus, hypertension, hiperlipidemia and older age. Ninety eight obese and 96 nonobese individuals without a comorbidity enrolled into the study. Serum ICAM-1 level was measured by enzyme linked immunoabsorbent assay (ELISA) method. ICAM-1 gene 1462A>G (K469E) polymorphism was examined by restriction fragment length polymorphism-polymerase chain reaction (RFLP-PCR). Nepholometric method was used to examine urinary albumin loss, and microalbuminuria was measured by albumin to creatinine ratio. Obese individuals had significantly higher microalbuminuria and proteinuria level compared to nonobese subjects (p: 0.043 and p: 0.011; respectively). GG genotype of ICAM-1 carriers have significantly higher microalbuminuria compared to individuals with AA or AG genotype carriers (p: 0.042). Serum ICAM-1 level was significantly correlated with creatinine and microalbuminuria (p: 0.002 and p: 0.03; respectively). Logistic regression analysis indicated a 7.39 fold increased risk of microalbuminuria in individuals with GG genotype of ICAM-1 gene 1462A>G (K469E) polymorphism. GG genotype of ICAM-1 gene K469E polymorphism is associated with increased microalbuminuria in obese individuals without another metabolic risk factor. Copyright © 2017 Sociedad Española de Nefrología. Published by Elsevier España, S.L.U. All rights reserved.

  14. The relationship between microalbuminuria, cardiovascular risk factors and disease management in type 2 diabetes.

    PubMed

    Udenze, I C; Azinge, E C; Ebuehi, O A T; Awolola, N A; Adekola, O O; Menkiti, I; Irurhe, N K

    2012-01-01

    In patients with type 2 diabetes, microalbuminuria is an early clinical sign suggestive of vascular damage to the glomerulus. Microalbuminuria has also been currently reported as an important risk factor for cardiovascular disease and becomes relevant in the management of type 2 diabetes. This study is to determine the prevalence of microalbuminuria, identify the risk factors associated with microalbuminuria in type 2 diabetes, and to asses the achievement of treatment goals for cardiovascular risk reduction in type 2 diabetics. Seventy- two subjects with microalbuminuria were recruited from three hundred consecutively screened type 2 diabetics attending the Diabetic Clinic at the Lagos University Teaching Hospital. Clinical data were obtained by interviewing the participants. Anthropometric measurements were made and blood specimens were collected for analysis. The prevalence of microalbuminuria was twenty-four percent (24%) in type 2 diabetes. Multiple logistic regression identified duration of diabetes (odds ratio 1.3 (95% CI; 0.03-1.58), hypertension(odds ratio 5.2 (95% Cl; 1.24-18.62), Body mass index (BMI) (odds ratio 1.27 (95% CI; 1.0-1.6), waist/hip ratio (WHR) (odds ratio 1.9 (95% Cl; 1.3-3.5), andHbA,c (odds ratio 6.6 (95% Cl; 1.02-27) as independent risk factors associated with microalbuminuria in type 2 diabetics. Optimum blood pressure, glycemic and weight control were achieved in eighty five percent (85%), fifty eight percent (58%) and nineteen percent (19%) of the type 2 diabetes respectively. This study showed that microalbuminuria is common among patients with type 2 diabetes. It also showed improvement in glycemic control and modifiable cardiovascular risk factor control when compared with previous studies.

  15. A Cost-Benefit and Accurate Method for Assessing Microalbuminuria: Single versus Frequent Urine Analysis.

    PubMed

    Hemmati, Roholla; Gharipour, Mojgan; Khosravi, Alireza; Jozan, Mahnaz

    2013-01-01

    Background. The purpose of this study was to answer the question whether a single testing for microalbuminuria results in a reliable conclusion leading costs saving. Methods. This current cross-sectional study included a total of 126 consecutive persons. Microalbuminuria was assessed by collection of two fasting random urine specimens on arrival to the clinic as well as one week later in the morning. Results. In overall, 17 out of 126 participants suffered from microalbuminuria that, among them, 12 subjects were also diagnosed as microalbuminuria once assessing this factor with a sensitivity of 70.6%, a specificity of 100%, a PPV of 100%, a NPV of 95.6%, and an accuracy of 96.0%. The measured sensitivity, specificity, PVV, NPV, and accuracy in hypertensive patients were 73.3%, 100%, 100%, 94.8%, and 95.5%, respectively. Also, these rates in nonhypertensive groups were 50.0%, 100%, 100%, 97.3%, and 97.4%, respectively. According to the ROC curve analysis, a single measurement of UACR had a high value for discriminating defected from normal renal function state (c = 0.989). Urinary albumin concentration in a single measurement had also high discriminative value for diagnosis of damaged kidney (c = 0.995). Conclusion. The single testing of both UACR and urine albumin level rather frequent testing leads to high diagnostic sensitivity, specificity, and accuracy as well as high predictive values in total population and also in hypertensive subgroups.

  16. Solar retinopathy.

    PubMed

    Galainena, M L

    1976-03-01

    Two cases of solar retinopathy following prolonged sun gazing are presented. Both patients were seen within an interval of 11 months, both with the diagnosis of schizophrenia paranoid type. These patients gave a history of sun gazing while praying to God, resulting in pigmentary disturbances of the macula, characterized by central and parafoveal depigmentation with perifoveal hyperpigmentation, as well as permanent impairment of vision in both eyes.

  17. Hydroxychloroquine retinopathy.

    PubMed

    Yusuf, I H; Sharma, S; Luqmani, R; Downes, S M

    2017-03-10

    Hydroxychloroquine (HCQ; Plaquenil) is used increasingly in the management of a variety of autoimmune disorders, with well established roles in dermatology and rheumatology and emerging roles in oncology. Hydroxychloroquine has demonstrated a survival benefit in patients with systemic lupus erythematosus; some clinicians advocate its use in all such patients. However, Hydroxychloroquine and chloroquine (CQ) have been associated with irreversible visual loss due to retinal toxicity. Hydroxychloroquine retinal toxicity is far more common than previously considered; an overall prevalence of 7.5% was identified in patients taking HCQ for greater than 5 years, rising to almost 20% after 20 years of treatment. This review aims to provide an update on HCQ/CQ retinopathy. We summarise emerging treatment indications and evidence of efficacy in systemic disease, risk factors for retinopathy, prevalence among HCQ users, diagnostic tests, and management of HCQ retinopathy. We highlight emerging risk factors such as tamoxifen use, and new guidance on safe dosing, reversing the previous recommendation to use ideal body weight, rather than actual body weight. We summarise uncertainties and the recommendations made by existing HCQ screening programmes. Asian patients with HCQ retinopathy may demonstrate an extramacular or pericentral pattern of disease; visual field testing and retinal imaging should include a wider field for screening in this group. HCQ is generally safe and effective for the treatment of systemic disease but because of the risk of HCQ retinal toxicity, modern screening methods and ideal dosing should be implemented. Guidelines regarding optimal dosing and screening regarding HCQ need to be more widely disseminated.Eye advance online publication, 10 March 2017; doi:10.1038/eye.2016.298.

  18. [IRMA-pRAcs: irbesartan in the treatment of microalbuminuria and proteinuria in patients with type 2 diabetes and hypertension-prospective observational study involving 38,016 patients in the general practice setting].

    PubMed

    Lehnert, H; Bramlage, P; Pittrow, D; Kirch, W

    2003-10-09

    In daily practice, nephropathy is diagnosed in a high percentage of type 2 diabetics, including those in whom blood pressure is well controlled. The aim of the present study was to reduce albuminuria in these patients by changing over antihypertensive treatment to the AT, blocker irbesartan. 9,838 general practitioners recruited a total of 38,016 type 2 diabetics aged at least 18 years to an open observational study: In the majority of cases, current antihyprertensive treatment was discontinued and patients given 300 mg (a small percentage received 150 mg or 75 mg) irbesartan, either as monotherapy or in combination with 12.5 mg hydrochlorothiazide (HCT). The primary target outcome for efficacy was the 6-months normalization rate in patients with microalbuminuria or proteinuria; secondary target parameters included the change in protein excretion (grades: negative, 20 mg, 50 mg, 100 mg), normalisation of the systolic or diastolic blood pressure, and responder and blood pressure normalization rates. The target criterion for tolerability was the number of patients with adverse events (AE). 46% of the patients were controlled with 300 mg irbesartan alone, and 40% with irbesartan in combination with HCT. Albumin excretion normalized in 60.5% of the patients, improved by at least one grade in 81.9%, remained unchanged in 17.5%, and increased in 0.7% of the cases. The beneficial response was found to be independent ofthe type of prior antihypertensive treatment (including ACE-inhibitors) and was also seen in normotensive patients. Only 0.4 % of the patients reported AEs. In type 2 diabetics, treatment with 300 mg irbesartan administered alone or in combination with 12.5 mg HCT produced a pronounced nephroprotective effect.

  19. Eclipse retinopathy.

    PubMed Central

    Dhir, S. P.; Gupta, A.; Jain, I. S.

    1981-01-01

    Ten patients (13 eyes) suffered from varying degrees of eclipse retinopathy during a solar eclipse on 16 February 1980. There was no correlation between severity of the fundus lesions and the visual acuity. In 8 of the 10 eyes available for follow-up 6/6 or better visual acuity was seen. Early fluorescein studies revealed microleaks in 3 eyes (2 patients) and masking of choroidal fluorescence in 1 eye; however, 1 to 3 weeks later these eyes showed only faint window defects. It is postulated that in mild to moderate lesions there is a transient retinal capillary spasm, producing oedema in anterior retinal layers. Fluorescein angiography in such patients reveals no abnormality or only masking of choroidal fluorescence. However, severe cases develop micropunctures in the tight junctions of the pigment epithelium, leading to microleaks, which are sealed within a short period. Images PMID:7448156

  20. Eclipse retinopathy.

    PubMed

    Dhir, S P; Gupta, A; Jain, I S

    1981-01-01

    Ten patients (13 eyes) suffered from varying degrees of eclipse retinopathy during a solar eclipse on 16 February 1980. There was no correlation between severity of the fundus lesions and the visual acuity. In 8 of the 10 eyes available for follow-up 6/6 or better visual acuity was seen. Early fluorescein studies revealed microleaks in 3 eyes (2 patients) and masking of choroidal fluorescence in 1 eye; however, 1 to 3 weeks later these eyes showed only faint window defects. It is postulated that in mild to moderate lesions there is a transient retinal capillary spasm, producing oedema in anterior retinal layers. Fluorescein angiography in such patients reveals no abnormality or only masking of choroidal fluorescence. However, severe cases develop micropunctures in the tight junctions of the pigment epithelium, leading to microleaks, which are sealed within a short period.

  1. Takayasu's retinopathy.

    PubMed

    Elizalde, Javier; Capella, María José

    2011-12-01

    We report the case of a 63-year-old woman with Takayasu's arteritis who experienced progressive visual loss in her right eye (RE) over several months. Visual acuity was 0.4 in the RE, which showed marked retinal arteriovenous dilation and highly irregular arteriolar calibre. She had no light perception in the left eye, which showed diffuse atrophy of the retinal pigment epithelium and prepapillary fibrovascular proliferation. Fluorescein angiography revealed delayed and slow retinal and choroidal circulation and areas of peripheral ischemia. A diagnosis of Takayasu's retinopathy was made and the non-perfused areas were treated with laser photocoagulation. Takayasu's disease can result in chronic ocular ischemia. Angiographic examination is particularly important in this context and may provide additional findings which affect staging and treatment of the disease. The role of the ophthalmologist includes laser photocoagulation, monitoring for complications and timely referral for vascular surgery.

  2. Eclipse retinopathy.

    PubMed

    Michaelides, M; Rajendram, R; Marshall, J; Keightley, S

    2001-04-01

    Solar retinopathy is a well-recognised clinical entity of macular damage caused by viewing the sun, induced by a photochemical process. The term 'eclipse retinopathy' is frequently employed when the condition is sustained as a result of viewing a solar eclipse. Considerable public excitement had been raised in anticipation of the full solar eclipse on 11 August 1999. Whilst experience has shown that visual morbidity is likely to be temporary, current evidence is anecdotal and restricted to isolated case reports and series. This study was conducted to establish the true visual morbidity associated with a solar eclipse, and whether it was temporary or permanent. A 3 month active case ascertainment study was carried out from July to September 1999 to record cases presenting to ophthalmologists with visual symptoms arising from solar viewing. Further information about the cases was sought using a short questionnaire. A follow-up questionnaire requesting outcome data at 6 months was also employed. There were 70 reported cases of visual loss. The average age was 29.5 +/- 12.9 years. Half the cases presented to an ophthalmologist within 2 days of the eclipse. An abnormal macular appearance was reported in 84% of patients at presentation. There have been no reported cases of continued visual loss or symptoms at 6 months. This is the largest nationwide study of the visual effects of a solar eclipse ever undertaken. There were no recorded cases of permanent visual loss, which corroborates the previous evidence that visual morbidity is likely to be temporary. It would appear probable that public health education was most effective in reducing visual morbidity and hence keeping the consequent burden on the NHS to a minimum.

  3. [Hypertension].

    PubMed

    Ohishi, Mitsuru

    2014-04-01

    Hypertension is well known to one of the risk factors to reduce cognitive function, however, it is still unclear whether anti-hypertensive therapy is effective to prevent development of dementia or Alzheimer's disease. Epidemiological studies suggested antihypertensive therapy from the middle-age could reduce risk of dementia. The meta-analysis including HYVET also suggested blood pressure lowering from the elderly might be also effective to prevent development of dementia. The network meta-analysis and the cohort study using mega-data bank suggested ARB might be effective to prevent development of dementia or Alzheimer's disease compared to administration with other anti-hypertensive drugs. Although the further major clinical investigation is required, anti-hypertensive treatment might be useful to manage hypertensive patients with dementia.

  4. Genomic and Metabolomic Profile Associated to Microalbuminuria

    PubMed Central

    Marrachelli, Vannina G.; Monleon, Daniel; Rentero, Pilar; Mansego, María L.; Morales, Jose Manuel; Galan, Inma; Segura, Remedios; Martinez, Fernando; Martin-Escudero, Juan Carlos; Briongos, Laisa; Marin, Pablo; Lliso, Gloria; Chaves, Felipe Javier; Redon, Josep

    2014-01-01

    To identify factors related with the risk to develop microalbuminuria using combined genomic and metabolomic values from a general population study. One thousand five hundred and two subjects, Caucasian, more than 18 years, representative of the general population, were included. Blood pressure measurement and albumin/creatinine ratio were measured in a urine sample. Using SNPlex, 1251 SNPs potentially associated to urinary albumin excretion (UAE) were analyzed. Serum metabolomic profile was assessed by 1H NMR spectra using a Brucker Advance DRX 600 spectrometer. From the total population, 1217 (mean age 54±19, 50.6% men, ACR>30 mg/g in 81 subjects) with high genotyping call rate were analysed. A characteristic metabolomic profile, which included products from mitochondrial and extra mitochondrial metabolism as well as branched amino acids and their derivative signals, were observed in microalbuminuric as compare to normoalbuminuric subjects. The comparison of the metabolomic profile between subjects with different UAE status for each of the genotypes associated to microalbuminuria revealed two SNPs, the rs10492025_TT of RPH3A gene and the rs4359_CC of ACE gene, with minimal or no statistically significant differences. Subjects with and without microalbuminuria, who shared the same genotype and metabolomic profile, differed in age. Microalbuminurics with the CC genotype of the rs4359 polymorphism and with the TT genotype of the rs10492025 polymorphism were seven years older and seventeen years younger, respectively as compared to the whole microalbuminuric subjects. With the same metabolomic environment, characteristic of subjects with microalbuminuria, the TT genotype of the rs10492025 polymorphism seems to increase and the CC genotype of the rs4359 polymorphism seems to reduce risk to develop microalbuminuria. PMID:24918908

  5. Hypertension.

    PubMed

    Fitzgerald, Kara; Lepine, Todd

    2012-05-01

    Hypertension is responsible for roughly one-in-six adult deaths annually in the United States and is associated with five of the top nine causes of death.(1) Ten trillion dollars is the estimated annual cost worldwide of the direct and indirect effects of hypertension.(2,3) In the U.S. alone, costs estimated at almost $74 billion in 2009 placed a huge economic burden on the health care system.(4) The prevalence of hypertension increases with advancing age to the point where more than half of people 60 to 69 years of age and at least three-fourths of those 70 years of age and older are affected.(5) Most individuals with hypertension do not have it adequately controlled.(1,6) Medication noncompliance due to avoidance of side effects is suggested to be a primary factor.(6) The epidemic incidence of hypertension and its significant cost to society indicate that a well-tolerated, cost-effective approach to treatment is urgently needed.

  6. Risk factors for retinopathy in diabetes mellitus in Kelantan, Malaysia.

    PubMed

    Shriwas, S R; Rahman Isa, A B; Reddy, S C; Mohammad, M; Mohammad, W B; Mazlan, M

    1996-12-01

    Few attempts have been made to determine the risk factors for diabetic retinopathy which is a major cause of visual impairment and blindness. One hundred and forty patients of diabetes mellitus were studied to determine the prevalence and types of retinopathy, and its relation to various risk factors. Nearly half (48.6%) of the patients suffered from retinopathy. The significant associated risk factors were long duration of diabetes, proteinuria and elevated serum creatinine level. However, there was no significant association between the prevalence of retinopathy and high levels of serum cholesterol, C-peptide levels, associated hypertension, and glycaemic control of diabetes mellitus. An effective screening programme for detection of retinopathy in the patients of diabetes as a regular practice is encouraged.

  7. Association of irisin concentrations with the presence of diabetic nephropathy and retinopathy.

    PubMed

    Hu, Wenchao; Wang, Rui; Li, Jun; Zhang, Jie; Wang, Wenhui

    2016-01-01

    Irisin, a recently identified myokine, is involved in the protection of mice against obesity and diabetes. This study aims to determine the serum and vitreous concentrations of irisin in patients with diabetic nephropathy and diabetic retinopathy. A total of 178 patients with type 2 diabetes mellitus, as well as 22 type 2 diabetes mellitus patients without diabetic retinopathy and 35 patients with proliferative diabetic retinopathy were enrolled in this study. Serum irisin concentrations were significantly elevated in the control group compared with those in type 2 diabetes mellitus patients. Furthermore, type 2 diabetes mellitus patients with macroalbuminuria exhibited significantly lower serum irisin concentrations than the controls and type 2 diabetes mellitus patients with normoalbuminuria and microalbuminuria. Simple regression analysis showed that the serum irisin concentrations in type 2 diabetes mellitus patients were negatively correlated with age, fasting plasma glucose, homeostasis model assessment of insulin resistance, blood urea nitrogen, creatinine, and positively correlated with creatinine clearance and angiotensin-converting enzyme inhibitors/angiotensin receptor blockers treatment. Proliferative diabetic retinopathy patients showed significantly decreased serum and vitreous irisin concentrations compared with the control group and type 2 diabetes mellitus patients without diabetic retinopathy. Furthermore, decreased serum and vitreous irisin concentrations were found in type 2 diabetes mellitus patients without diabetic retinopathy than those in the controls. Irisin concentrations are associated with the presence of diabetic nephropathy and diabetic retinopathy. © The Author(s) 2015.

  8. Retinopathy in old persons with and without diabetes mellitus: the Age, Gene/Environment Susceptibility—Reykjavik Study (AGES-R)

    PubMed Central

    Gunnlaugsdottir, E.; Halldorsdottir, S.; Klein, R.; Eiriksdottir, G.; Klein, B. E.; Benediktsson, R.; Harris, T. B.; Launer, L. J.; Aspelund, T.; Gudnason, V.

    2012-01-01

    Aims/hypothesis We aimed to describe the prevalence of retinopathy in an aged cohort of Icelanders with and without diabetes mellitus. Methods The study population consisted of 4,994 persons aged ≥67 years, who participated in the Age, Gene/Environment Susceptibility—Reykjavik Study (AGES-R). Type 2 diabetes mellitus was defined as HbA1c ≥6.5% (>48 mmol/mol). Retinopathy was assessed by grading fundus photographs using the modified Airlie House adaptation of the Early Treatment Diabetic Retinopathy Study protocol. Associations between retinopathy and risk factors were estimated using odds ratios obtained from multivariate analyses. Results The overall prevalence of retinopathy in AGES-R was 12.4%. Diabetes mellitus was present in 516 persons (10.3%), for 512 of whom gradable fundus photos were available, including 138 persons (27.0%, 95% CI 23.2, 31.0) with any retinopathy. Five persons (1.0%, 95% CI 0.3, 2.3) had proliferative retinopathy. Clinically significant macular oedema was present in five persons (1.0%, 95% CI 0.3, 2.3). Independent risk factors for retinopathy in diabetic patients in a multivariate model included HbA1c, insulin use and use of oral hypoglycaemic agents, the last two being indicators of longer disease duration. In 4478 participants without diabetes mellitus, gradable fundus photos were available for 4,453 participants, with retinopathy present in 476 (10.7%, 95% CI 9.8, 11.6) and clinically significant macular oedema in three persons. Independent risk factors included increasing age and microalbuminuria. Conclusions/interpretation Over three-quarters (78%) of retinopathy cases were found in persons without diabetes and a strong association between microalbuminuria and non-diabetic retinopathy was found. These results may have implications for patient management of the aged. PMID:22134840

  9. Lifestyle-related factors, obesity, and incident microalbuminuria: the CARDIA (Coronary Artery Risk Development in Young Adults) study.

    PubMed

    Chang, Alex; Van Horn, Linda; Jacobs, David R; Liu, Kiang; Muntner, Paul; Newsome, Britt; Shoham, David A; Durazo-Arvizu, Ramon; Bibbins-Domingo, Kirsten; Reis, Jared; Kramer, Holly

    2013-08-01

    Modifiable lifestyle-related factors are associated with risk of coronary heart disease and may also influence kidney disease risk. Community-based prospective cohort study. 2,354 African American and white participants aged 28-40 years without baseline microalbuminuria or estimated glomerular filtration rate <60 mL/min/1.73 m² recruited from 4 US centers: Birmingham, AL; Chicago, IL; Minneapolis, MN; and Oakland, CA. Current smoking, physical activity, fast food habits, obesity, and diet quality, which was based on 8 fundamental components of the Dietary Approaches to Stop Hypertension (DASH) diet, including increased intake of fruits, vegetables, low-fat dairy products, whole grains, and nuts and legumes and reduced intake of sodium, sugar-sweetened beverages, and red and processed meats. Spot urine albumin-creatinine ratios were obtained at baseline (1995-1996) and three 5-year follow-up examinations (5, 10, and 15 years' follow-up). Incident microalbuminuria was defined as the presence of age- and sex-adjusted albumin-creatinine ratio ≥25 mg/g at 2 or more of the successive follow-up examinations. During the 15-year follow-up, 77 (3.3%) individuals developed incident microalbuminuria. After multivariable adjustment, poor diet quality (OR, 2.0; 95% CI, 1.1-3.4) and obesity (OR, 1.9; 95% CI, 1.1-3.3) were associated significantly with microalbuminuria; current smoking (OR, 1.6; 95% CI, 0.9-2.8) was associated with microalbuminuria, although the CI crossed 1.0. Neither low physical activity (OR, 1.0; 95% CI, 0.5-1.8) nor fast food consumption (OR, 1.2; 95% CI, 0.7-2.3) was associated with microalbuminuria. Compared with individuals with no unhealthy lifestyle-related factors (poor diet quality, current smoking, and obesity), adjusted odds of incident microalbuminuria were 131%, 273%, and 634% higher for the presence of 1 (OR, 2.3; 95% CI, 1.3-4.3), 2 (OR, 3.7; 95% CI, 1.8-7.7), and 3 (OR, 7.3; 95% CI, 2.1-26.1) unhealthy lifestyle-related factors. Self

  10. Microalbuminuria in a middle-aged workforce. Effect of hyperglycemia and ethnicity.

    PubMed

    Metcalf, P A; Baker, J R; Scragg, R K; Dryson, E; Scott, A J; Wild, C J

    1993-11-01

    To determine the prevalence of microalbuminuria in a mixed, ethnic population and to find the extent that ethnic variation in microalbuminuria can be explained by abnormal glucose metabolism, obesity, hypertension, hypertriglyceridemia, and life-style factors. Urinary albumin concentrations were measured in 5467 middle-aged Maori, Pacific Islander, and European workers who participated in a health-screening survey of 46 New Zealand companies. Participants provided a first-voided, morning urine sample; had a 75-g oral glucose tolerance test; had weight, height, and blood pressure measured; and completed a self-administered questionnaire about past medical history and sociodemographic status. A significantly higher prevalence of microalbuminuria was found in individuals with new cases of diabetes mellitus (24.1%), in cases of diabetes mellitus previously diagnosed (20.6%), and in those with impaired glucose tolerance (16.1%) compared with nondiabetic individuals (4.0%). Moreover, in the general population, a piecewise linear relationship was detected between albuminuria and plasma glucose with significant changes of slope corresponding with 2 h plasma glucose concentrations (95% confidence interval) of 6.7 (6.4-7.0) and 9.2 (8.6-9.8) mM, respectively. After adjusting for sex, obesity, hypertension, hypertriglyceridemia, cigarette smoking, and heavy alcohol consumption in a multivariate model, glycemia was the most significant determinant of urinary albumin concentrations in all three ethnic groups. However, blood glucose concentrations did not completely explain the higher relative risk (95% confidence interval) of microalbuminuria in Maori (5.97; 4.48-7.78) and Pacific Islander (5.33; 4.13-6.87) workers compared with European workers. Of the variables investigated, hyperglycemia was the most important factor explaining the high prevalence of microalbuminuria in Maori and Pacific Islander workers compared with the European workers. However, only 14.9% of the

  11. Long-term renal outcomes of patients with type 1 diabetes mellitus and microalbuminuria: an analysis of the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications cohort.

    PubMed

    de Boer, Ian H; Rue, Tessa C; Cleary, Patricia A; Lachin, John M; Molitch, Mark E; Steffes, Michael W; Sun, Wanjie; Zinman, Bernard; Brunzell, John D; White, Neil H; Danis, Ronald P; Davis, Matthew D; Hainsworth, Dean; Hubbard, Larry D; Nathan, David M

    2011-03-14

    Microalbuminuria is a common diagnosis in the clinical care of patients with type 1 diabetes mellitus. Long-term outcomes after the development of microalbuminuria are variable. We quantified the incidence of and risk factors for long-term renal outcomes after the development of microalbuminuria in the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) study. The DCCT randomly assigned 1441 persons with type 1 diabetes to intensive or conventional diabetes therapy, and participants were subsequently followed up during the observational EDIC study. During the DCCT/EDIC study, 325 participants developed incident persistent microalbuminuria (albumin excretion rate, ≥30 mg/24 h at 2 consecutive study visits). We assessed their subsequent renal outcomes, including progression to macroalbuminuria (albumin excretion rate, ≥300 mg/24 h at 2 consecutive visits), impaired glomerular filtration rate (estimated glomerular filtration rate, <60 mL/min/1.73 m(2) at 2 consecutive study visits), end-stage renal disease, and regression to normoalbuminuria (albumin excretion rate, <30 mg/24 h at 2 consecutive visits). The median follow-up period after persistent microalbuminuria diagnosis was 13 years (maximum, 23 years). Ten-year cumulative incidences of progression to macroalbuminuria, impaired glomerular filtration rate, end-stage renal disease, and regression to normoalbuminuria were 28%, 15%, 4%, and 40%, respectively. Albuminuria outcomes were more favorable with intensive diabetes therapy, lower glycated hemoglobin level, absence of retinopathy, female sex, lower blood pressure, and lower concentrations of low-density lipoprotein cholesterol and triglycerides. Lower glycated hemoglobin level, absence of retinopathy, and lower blood pressure were also associated with decreased risk of impaired glomerular filtration rate. After the development of persistent microalbuminuria, progression and regression of kidney

  12. Reduction of microalbuminuria in type-2 diabetes mellitus with angiotensin-converting enzyme inhibitor alone and with cilnidipine.

    PubMed

    Singh, V K; Mishra, A; Gupta, K K; Misra, R; Patel, M L; Shilpa

    2015-01-01

    The aim of our study was to find out the antiproteinuric effect of enalapril angiotensin-converting enzyme (ACE inhibitor) alone or in combination with cilnidipine in patients with type-2 diabetes mellitus. The study was conducted on 71 patients with type-2 diabetes mellitus patients with hypertension and microalbuminuria. They were divided into two groups randomly as follows: Group I (enalaprilalone, n = 36) and Group II (enalapril with cilnidipine, n = 35). In both the groups, baseline 24 h urinary albumin was estimated and was repeated every 3 months upto 1-year. After 1-year follow-up, reduction in microalbuminuria was found to be greater in Group II. In Group I microalbuminuria came down by 25.68 ± 21.40 while in Group II it reduced by 54.88 ± 13.84 (P < 0.001). We conclude that in diabetic population, cilnidipine has an additive effect in microalbuminuria reduction over and above the well-proven effect of ACE inhibitors.

  13. Diabetic Retinopathy: Nature and Extent.

    ERIC Educational Resources Information Center

    Coughlin, W. Ronald; Patz, Arnall

    1978-01-01

    The authors discuss the incidence and prevalence of diabetic retinopathy in juvenile and maturity onset diabetics, background and proliferative retinopathy, and current modalities of treatment. (Author)

  14. Diabetic Retinopathy: Nature and Extent.

    ERIC Educational Resources Information Center

    Coughlin, W. Ronald; Patz, Arnall

    1978-01-01

    The authors discuss the incidence and prevalence of diabetic retinopathy in juvenile and maturity onset diabetics, background and proliferative retinopathy, and current modalities of treatment. (Author)

  15. Nitric oxide in the pathophysiology of retinopathy: evidences from preclinical and clinical researches.

    PubMed

    Opatrilova, Radka; Kubatka, Peter; Caprnda, Martin; Büsselberg, Dietrich; Krasnik, Vladimir; Vesely, Pavol; Saxena, Sandeep; Ruia, Surabhi; Mozos, Ioana; Rodrigo, Luis; Kruzliak, Peter; Dos Santos, Katia Goncalves

    2017-04-08

    Retinopathy is the leading cause of blindness and visual disability in working-aged people. The pathogenesis of retinopathy is an actual and still open query. Alterations contributing to oxidative and nitrosative stress, including elevated nitric oxide and superoxide production, changes in the expression of different isoforms of nitric oxide synthase or endogenous antioxidant system, have been implicated in the mechanisms how this ocular disease develops. In addition, it was documented that renin-angiotensin system has been implicated in the progression of retinopathy. Based on comprehensive preclinical and clinical researches in this area, the role of above-mentioned factors in the pathogenesis of diabetic retinopathy, hypertensive retinopathy and ischaemic proliferative retinopathy is reviewed in this study. Moreover, the genetic susceptibility factors involved in the development of the retinopathy and possible strategies that utilize antioxidants as additive therapy are also highlighted here.

  16. Metabolic syndrome in hypertensive patients: An unholy alliance

    PubMed Central

    Mulè, Giuseppe; Calcaterra, Ilenia; Nardi, Emilio; Cerasola, Giovanni; Cottone, Santina

    2014-01-01

    For many years, it has been recognized that hypertension tends to cluster with various anthropometric and metabolic abnormalities including abdominal obesity, elevated triglycerides, reduced high-density lipoprotein cholesterol, glucose intolerance, insulin resistance and hyperuricemia. This constellation of various conditions has been transformed from a pathophysiological concept to a clinical entity, which has been defined metabolic syndrome (MetS). The consequences of the MetS have been difficult to assess without commonly accepted criteria to diagnose it. For this reason, on 2009 the International Diabetes Federation, the American Heart Association and other scientific organizations proposed a unified MetS definition. The incidence of the MetS has been increasing worldwide in parallel with an increase in overweight and obesity. The epidemic proportion reached by the MetS represents a major public health challenge, because several lines of evidence showed that the MetS, even without type 2 diabetes, confers an increased risk of cardiovascular morbidity and mortality in different populations including also hypertensive patients. It is likely that the enhanced cardiovascular risk associated with MetS in patients with high blood pressure may be largely mediated through an increased prevalence of preclinical cardiovascular and renal changes, such as left ventricular hypertrophy, early carotid atherosclerosis, impaired aortic elasticity, hypertensive retinopathy and microalbuminuria. Indeed, many reports support this notion, showing that hypertensive patients with MetS exhibit, more often than those without it, these early signs of end organ damage, most of which are recognized as significant independent predictors of adverse cardiovascular outcomes. PMID:25276291

  17. Free triiodothyronine concentrations are inversely associated with microalbuminuria.

    PubMed

    Zhou, Yulin; Ye, Lei; Wang, Tiange; Hong, Jie; Bi, Yufang; Zhang, Jie; Xu, Baihui; Sun, Jichao; Huang, Xiaolin; Xu, Min

    2014-01-01

    Thyroid function and microalbuminuria are both associated with vascular disease and endothelial damage. However, whether thyroid function is associated with microalbuminuria is not well established. The objective was to explore the relationship between thyroid hormones and microalbuminuria in Chinese population. A community-based cross-sectional study was performed among 3,346 Chinese adults (aged ≥ 40 years). Serum free triiodothyronine (FT3), free thyroxine (FT4), and TSH (thyroid stimulating hormone) were determined by chemiluminescent microparticle immunoassay. A single-void first morning urine sample was obtained for urinary albumin-creatinine ratio measurement. The prevalence of microalbuminuria decreased according to FT3 quartiles (13.2, 9.5, 8.6, and 8.2%, P for trend = 0.0005). A fully adjusted logistic regression analysis showed that high FT3 levels were associated with low prevalent microalbuminuria. The adjusted odds ratios for microalbuminuria were 0.61 (95% CI, 0.43-0.87, P = 0.007) when comparing the highest with the lowest quartile of FT3. The exclusion of participants with abnormal FT3 did not appreciably change the results (OR = 0.69, 95% CI, 0.49-0.98, P = 0.02). We concluded that serum FT3 levels, even within the normal range, were inversely associated with microalbuminuria in middle-aged and elderly Chinese adults. FT3 concentrations might play a role in the pathogenesis of microalbuminuria.

  18. Microalbuminuria and pegylated interferon in hepatitis-C patients.

    PubMed

    Elshahawi, Yasser; Sany, Dawlat; Abd Elmohsen, Walid Anwar; Tantawi, Tarek

    2015-11-01

    To determine the relation between hepatitis C virus (HCV) genotype 4 and microalbuminuria in relation to hepatic histology and viremia in the absence of cryoglobulinemia and to examine the effect of treatment on microalbuminuria, we studied 400 HCV genotype-4-infected patients who were tested for microalbuminuria, albumin creatinine ratio (ACR), urea, creatinine and estimated glomerular filtration rate (eGFR). The parameters were measured again in the HCV patients after six months of treatment with pegylated interferon and ribavirin. Microalbuminuria was detected in 56 (14%) HCV-positive patients. There was a highly significant reduction in the microalbuminuria levels among the HCV-positive individuals after six months of therapy (P <0.001). Microalbuminuria was significantly associated with older age [Odds Ratio (OR): 1.1, 95% confidence interval (CI): 1.0-1.2, P = 0.01], elevated creatinine (OR: 0.09, 95% CI: 0.01- 0.7, P = 0.02), high modified Histological Activity Index score (OR: 1.5, 95% CI: 1.1-1.5, P = 0.004) and increased viral load (OR: 2.8, 95% CI: 1.1-6.6, P = 0.01). Sustained virological response (SRV) was achieved in 272 (86%) patients. The individuals with SVR had lower microalbuminuria post-treatment (P = 0.56). We conclude that HCV infection can be associated with microalbuminuria, which can be reduced by the use of a combination therapy of pegylated interferon-ribavirin.

  19. Retinopathy of Prematurity

    ERIC Educational Resources Information Center

    Steinweg, Sue Byrd; Griffin, Harold C.; Griffin, Linda W.; Gingras, Happy

    2005-01-01

    The eyes of premature infants are especially vulnerable to injury after birth. A serious complication is called retinopathy of prematurity (ROP), which is abnormal growth of the blood vessels in an infant's eye. Retinopathy of prematurity develops when abnormal blood vessels grow and spread throughout the retina, which is the nerve tissue at the…

  20. Retinopathy of Prematurity

    ERIC Educational Resources Information Center

    Steinweg, Sue Byrd; Griffin, Harold C.; Griffin, Linda W.; Gingras, Happy

    2005-01-01

    The eyes of premature infants are especially vulnerable to injury after birth. A serious complication is called retinopathy of prematurity (ROP), which is abnormal growth of the blood vessels in an infant's eye. Retinopathy of prematurity develops when abnormal blood vessels grow and spread throughout the retina, which is the nerve tissue at the…

  1. High-normal diastolic blood pressure is a risk for development of microalbuminuria in the general population: the Watari study.

    PubMed

    Konno, Satoshi; Hozawa, Atsushi; Miura, Yukio; Ito, Sadayoshi; Munakata, Masanori

    2013-04-01

    Although hypertension is a well known risk factor for microalbuminuria, it is unclear whether blood pressure less than 140/90 mmHg could be a risk for microalbuminuria. We assessed the relationship between baseline blood pressure and the future onset of microalbuminuria in the general population. We studied 2603 town inhabitants of Watari, located in the southeastern part of Miyagi prefecture, Japan. Demographic data, medical history, sitting blood pressure, fasting blood chemistry, and urinary albumin-creatinine ratio were measured at baseline and were followed annually during the next 3 years. Among 2338 individuals who were normoalbuminuric at baseline (albumin-creatinine ratio <30 mg/g Cr), 161 developed microalbuminuria (albumin-creatinine ratio 30-299 mg/g Cr) during a mean follow-up period of 2.4 years. Incident microalbuminuria patients were older (63.7 ± 8.6 vs. 61.4 ± 10.5 years; P < 0.01), included fewer men (31.1 vs. 40.1%; P < 0.05), had a greater BMI (23.8 ± 3.6 vs. 23.1 ± 3.1 kg/m²; P < 0.01), higher blood pressures (133.5 ± 18.1/75.8 ± 11.9 vs. 127.6 ± 18.1/73.4 ± 11.0 mmHg; P < 0.01 for both systolic and diastolic), higher triglycerides (median 1.18 vs. 1.02 mmol/l; P < 0.01), higher fasting blood glucose (median 5.05 vs. 4.94 mmol/l; P < 0.01), higher urinary albumin excretion (median 13.0 vs. 5.9 mg/g Cr; P < 0.001), and lower serum creatinine concentrations (59.2 ± 12.8 vs. 61.4 ± 13.2 μmol/l; P < 0.05) compared to persistent normoalbuminuric individuals. Multivariate Cox proportional hazards analysis including all covariates revealed that only baseline urinary albumin excretion was an independent predictor for future microalbuminuria, whereas high-normal DBP, triglyceride, and fasting blood glucose concentrations were all significant predictors in the model excluding urinary albumin excretion. High-normal DBP associated with metabolic disorders could initiate glomerular damage, leading to future microalbuminuria.

  2. High prevalence of microalbuminuria in chronic heart failure patients.

    PubMed

    van de Wal, Ruud M A; Asselbergs, Folkert W; Plokker, H W Thijs; Smilde, Tom D J; Lok, Dirk; van Veldhuisen, Dirk J; van Gilst, Wiek H; Voors, Adriaan A

    2005-10-01

    Microalbuminuria is associated with increased risk for cardiovascular morbidity and mortality. However, the relation between microalbuminuria and chronic heart failure has not been well described yet. In this cross-sectional study, we aim to evaluate the prevalence of microalbuminuria and the association with neurohormonal parameters in severe chronic heart failure patients. We studied 94 stable chronic heart failure patients (New York Heart Association class III/IV) receiving therapy with angiotensin-converting enzyme (ACE) inhibitors for over three months. In all patients, renal function and neurohormonal status were evaluated and correlated with urinary albumin/creatinine ratio. The studied population consisted of 70 men and 21 women (mean age 69 +/- 12 years). Ischemia was the underlying cause of heart failure in 61 patients. Overall, 100% of the patients were treated with an ACE inhibitor, 72% with a beta-blocker, and 47% with spironolactone. In 32% (95% confidence interval 22-42) of the patients, microalbuminuria was present, which is significantly higher than in the general population. However, we found no significant association between the presence of microalbuminuria and renal function. Plasma NT-proBNP, active renin protein, angiotensin I, angiotensin II, and aldosterone did not differ significantly between groups with and without microalbuminuria. In 32% of the patients, microalbuminuria was present. No association was found with either renal or neurohormonal parameters.

  3. COPD and microalbuminuria: a 12-year follow-up study.

    PubMed

    Romundstad, Solfrid; Naustdal, Thor; Romundstad, Pål Richard; Sorger, Hanne; Langhammer, Arnulf

    2014-04-01

    Chronic obstructive pulmonary disease (COPD), low lung function independent of diagnosis and markers of inflammation are all associated with increased morbidity and mortality. Microalbuminuria, reflecting endothelial dysfunction, could be a relevant inflammatory marker of potential systemic effects of COPD. We hypothesised that there was a positive association between microalbuminuria and mortality in individuals with COPD. We conducted a 12-year follow-up study of 3129 participants in the second survey of the Nord-Trøndelag Health Study (HUNT), Norway. At baseline, albuminuria was analysed in three urine samples and spirometry was performed. Among the participants, 136 had COPD and microalbuminuria, defined as a urinary albumin/creatinine ratio between 2.5 and 30.0 mg·mmol(-1). The main outcome measures were hazard ratio of all-cause mortality according to microalbuminuria. Compared to those with COPD without microalbuminuria, the adjusted hazard ratio for all-cause mortality in those with COPD and microalbuminuria was 1.54, 95% CI 1.16-2.04. This result was similar after excluding cardiovascular disease at baseline. Classifying COPD severity by Global Initiative for Chronic Obstructive Lung Disease, there was a positive association trend with increasing severity stages. Microalbuminuria is associated with all-cause mortality in individuals with COPD and could be a relevant tool in identification of patients with poor prognosis.

  4. Visceral obesity is associated with microalbuminuria in nondiabetic Asians.

    PubMed

    Kim, Hyunsuk; Kim, Hyo Jin; Shin, Nara; Han, Miyeon; Park, HyoEun; Kim, Minkyung; Kwon, Hyuktae; Choi, Su-Yeon; Heo, Nam Ju

    2014-07-01

    Microalbuminuria is an indicator of renal disease and is known to be related to obesity. The aim of this study is to investigate the association between the cross-sectional area of visceral adipose tissue (VAT) and the prevalence of microalbuminuria. We conducted a cross-sectional study of 1154 subjects who underwent routine checkups, including computed tomography (CT) scans of abdominal adipose tissue. We used the lowest tertile as a reference of abdominal fat. The highest tertile of VAT was related to the highest prevalence of microalbuminuria (odds ratio (OR): 1.96; 95% CI: 1.12-3.43). Subcutaneous adipose tissue (SAT) was not associated with microalbuminuria. In men, the highest tertile for VAT was associated with the highest prevalence of microalbuminuria (OR: 2.74; 95% CI: 1.44-5.22). In women, VAT or SAT was not associated with microalbuminuria. In nondiabetic subjects, the highest tertile for VAT was associated with the highest prevalence of microalbuminuria (OR: 2.23; 95% CI: 1.15-4.32). Among subjects without metabolic syndrome or with body mass index <25 kg m(-2), the highest tertile for VAT was associated with microalbuminuria in age- and sex-adjusted model, respectively (OR: 1.62; 95% CI: 1.01-2.31; OR: 2.21; 95% CI: 1.05-4.65). The analysis of the association of VAT and insulin resistance (IR) indicated that a higher VAT was associated with a higher IR (highest tertile for VAT-OR: 2.91; 95% CI: 1.70-4.96). In conclusion, the highest VAT of the current study was significantly correlated with the highest prevalence of microalbuminuria, even in traditionally low-risk subjects without diabetes, and this association is potentially related with a higher IR.

  5. Biomarkers in Diabetic Retinopathy

    PubMed Central

    Jenkins, Alicia J.; Joglekar, Mugdha V.; Hardikar, Anandwardhan A.; Keech, Anthony C.; O'Neal, David N.; Januszewski, Andrzej S.

    2015-01-01

    There is a global diabetes epidemic correlating with an increase in obesity. This coincidence may lead to a rise in the prevalence of type 2 diabetes. There is also an as yet unexplained increase in the incidence of type 1 diabetes, which is not related to adiposity. Whilst improved diabetes care has substantially improved diabetes outcomes, the disease remains a common cause of working age adult-onset blindness. Diabetic retinopathy is the most frequently occurring complication of diabetes; it is greatly feared by many diabetes patients. There are multiple risk factors and markers for the onset and progression of diabetic retinopathy, yet residual risk remains. Screening for diabetic retinopathy is recommended to facilitate early detection and treatment. Common biomarkers of diabetic retinopathy and its risk in clinical practice today relate to the visualization of the retinal vasculature and measures of glycemia, lipids, blood pressure, body weight, smoking, and pregnancy status. Greater knowledge of novel biomarkers and mediators of diabetic retinopathy, such as those related to inflammation and angiogenesis, has contributed to the development of additional therapeutics, in particular for late-stage retinopathy, including intra-ocular corticosteroids and intravitreal vascular endothelial growth factor inhibitors ('anti-VEGFs') agents. Unfortunately, in spite of a range of treatments (including laser photocoagulation, intraocular steroids, and anti-VEGF agents, and more recently oral fenofibrate, a PPAR-alpha agonist lipid-lowering drug), many patients with diabetic retinopathy do not respond well to current therapeutics. Therefore, more effective treatments for diabetic retinopathy are necessary. New analytical techniques, in particular those related to molecular markers, are accelerating progress in diabetic retinopathy research. Given the increasing incidence and prevalence of diabetes, and the limited capacity of healthcare systems to screen and treat

  6. Biomarkers in Diabetic Retinopathy.

    PubMed

    Jenkins, Alicia J; Joglekar, Mugdha V; Hardikar, Anandwardhan A; Keech, Anthony C; O'Neal, David N; Januszewski, Andrzej S

    2015-01-01

    There is a global diabetes epidemic correlating with an increase in obesity. This coincidence may lead to a rise in the prevalence of type 2 diabetes. There is also an as yet unexplained increase in the incidence of type 1 diabetes, which is not related to adiposity. Whilst improved diabetes care has substantially improved diabetes outcomes, the disease remains a common cause of working age adult-onset blindness. Diabetic retinopathy is the most frequently occurring complication of diabetes; it is greatly feared by many diabetes patients. There are multiple risk factors and markers for the onset and progression of diabetic retinopathy, yet residual risk remains. Screening for diabetic retinopathy is recommended to facilitate early detection and treatment. Common biomarkers of diabetic retinopathy and its risk in clinical practice today relate to the visualization of the retinal vasculature and measures of glycemia, lipids, blood pressure, body weight, smoking, and pregnancy status. Greater knowledge of novel biomarkers and mediators of diabetic retinopathy, such as those related to inflammation and angiogenesis, has contributed to the development of additional therapeutics, in particular for late-stage retinopathy, including intra-ocular corticosteroids and intravitreal vascular endothelial growth factor inhibitors ('anti-VEGFs') agents. Unfortunately, in spite of a range of treatments (including laser photocoagulation, intraocular steroids, and anti-VEGF agents, and more recently oral fenofibrate, a PPAR-alpha agonist lipid-lowering drug), many patients with diabetic retinopathy do not respond well to current therapeutics. Therefore, more effective treatments for diabetic retinopathy are necessary. New analytical techniques, in particular those related to molecular markers, are accelerating progress in diabetic retinopathy research. Given the increasing incidence and prevalence of diabetes, and the limited capacity of healthcare systems to screen and treat

  7. Rosiglitazone reduces microalbuminuria and blood pressure independently of glycemia in type 2 diabetes patients with microalbuminuria.

    PubMed

    Bakris, George L; Ruilope, Luis M; McMorn, Stephen O; Weston, Wayde M; Heise, Mark A; Freed, Martin I; Porter, Lisa E

    2006-10-01

    To test the hypothesis that rosiglitazone combined with metformin provides a greater reduction in microalbuminuria and blood pressure than metformin and glyburide at comparable levels of glycemic control. In a double-blind, parallel-group design 389 participants with type 2 diabetes were followed for 32 weeks. Urinary albumin: creatinine ratio was significantly reduced at 32 weeks compared with baseline in the rosiglitazone plus metformin group (-22.7%; P < 0.01) but not in the glyburide plus metformin comparator group (-7.1%; P = 0.32). Patients who completed the study (81.5%) demonstrated a treatment difference of -19.5% (P = 0.03), favoring the rosiglitazone group. Rosiglitazone plus metformin reduced both mean 24-h systolic (-3.4 mmHg; P = 0.01) and diastolic (-2.5 mmHg; P < 0.01) ambulatory blood pressure compared with glyburide plus metformin. Addition of rosiglitazone to metformin also reduced levels of plasminogen activator inhibitor-1 antigen and activity, C-reactive protein, von Willebrand factor and fibrinogen compared with addition of glyburide. Rosiglitazone added to background therapy with metformin provides greater reductions in microalbuminuria and blood pressure as compared with glyburide. These additional improvements in microalbuminuria, blood pressure and cardiovascular biomarkers were observed despite comparable improvements in glycemic control in both groups and may be related to the anti-inflammatory properties of rosiglitazone.

  8. Diabetic Retinopathy Analysis.

    PubMed

    Sivakumar, R; Ravindran, G; Muthayya, M; Lakshminarayanan, S; Velmurughendran, C U

    2005-01-01

    Diabetic retinopathy is one of the common complications of diabetes. Unfortunately, in many cases the patient is not aware of any symptoms until it is too late for effective treatment. Through analysis of evoked potential response of the retina, the optical nerve, and the optical brain center, a way will be paved for early diagnosis of diabetic retinopathy and prognosis during the treatment process. In this paper, we present an artificial-neural-network-based method to classify diabetic retinopathy subjects according to changes in visual evoked potential spectral components and an anatomically realistic computer model of the human eye under normal and retinopathy conditions in a virtual environment using 3D Max Studio and Windows Movie Maker.

  9. Blood pressure control for diabetic retinopathy.

    PubMed

    Do, Diana V; Wang, Xue; Vedula, Satyanarayana S; Marrone, Michael; Sleilati, Gina; Hawkins, Barbara S; Frank, Robert N

    2015-01-31

    Diabetic retinopathy is a common complication of diabetes and a leading cause of visual impairment and blindness. Research has established the importance of blood glucose control to prevent development and progression of the ocular complications of diabetes. Simultaneous blood pressure control has been advocated for the same purpose, but findings reported from individual studies have supported varying conclusions regarding the ocular benefit of interventions on blood pressure. The primary aim of this review was to summarize the existing evidence regarding the effect of interventions to control or reduce blood pressure levels among diabetics on incidence and progression of diabetic retinopathy, preservation of visual acuity, adverse events, quality of life, and costs. A secondary aim was to compare classes of anti-hypertensive medications with respect to the same outcomes. We searched a number of electronic databases including CENTRAL as well as ongoing trial registries. We last searched the electronic databases on 25 April 2014. We also reviewed reference lists of review articles and trial reports selected for inclusion. In addition, we contacted investigators of trials with potentially pertinent data. We included in this review randomized controlled trials (RCTs) in which either type 1 or type 2 diabetic participants, with or without hypertension, were assigned randomly to intense versus less intense blood pressure control, to blood pressure control versus usual care or no intervention on blood pressure, or to different classes of anti-hypertensive agents versus placebo. Pairs of review authors independently reviewed titles and abstracts from electronic and manual searches and the full text of any document that appeared to be relevant. We assessed included trials independently for risk of bias with respect to outcomes reported in this review. We extracted data regarding trial characteristics, incidence and progression of retinopathy, visual acuity, quality of life

  10. 'Progressive diabetic nephropathy. How useful is microalbuminuria?: contra'.

    PubMed

    MacIsaac, Richard J; Ekinci, Elif I; Jerums, G

    2014-07-01

    The concept of microalbuminuria has been central to the development of clinical practice and research in the area of diabetic kidney disease (DKD). However, in recent times, the value of a paradigm of DKD based solely on microalbuminuria has been questioned. Although both the absolute level and rate of change of microalbuminuria are linked to the development and progression of DKD, microalbuminuria on its own lacks the necessary sensitivity or specificity to accurately predict kidney outcomes for people with diabetes. The development of microalbumiuria can no longer be viewed as a committed and irreversible stage of DKD, as spontaneous remission is now reported as a common occurrence. In addition, the absence of microalbuminuria or its progression to proteinuria does not signify that an individual patient is safe from a progressive decline in glomerular filtration rate (GFR). Furthermore, although reductions in albuminuria within the microalbuminuric range can be linked to a slower GFR decline in observational studies, this relationship has not been robustly demonstrated in intervention studies. Conclusions regarding the kidney health of individuals with diabetes will continue to be flawed if an inappropriate emphasis is placed on the presence or absence of albuminuria or changes in albuminuria within the microalbuminuric range. This has important implications in terms of undermining the value of microalbuminuria as a surrogate renal end point for intervention trials. There is a need to develop broader models of progressive DKD that include novel pathways and risk markers apart from those related to the traditional 'albuminuric pathway' to renal impairment.

  11. [Microabluminuria in arterial hypertension. Measurement, variables, interpretation, recommendations].

    PubMed

    Hornych, A; Marre, M; Mimran, A; Chaignon, M; Asmar, R; Fauvel, J P

    2000-11-01

    Permanent hypertension is frequently associated with increased glomerular permeability to albumin at an early stage, indicating renal involvement and endothelial dysfunction. The definition of microalbuminuria is an urinary albumin excretion of 30-300 mg/24 hrs, confirmed on two occasions over a 3 month period. It may also be expressed in microgram/min, m/l or mg/mmol of creatinine. Radio-immunological, immunonephelometric methods and Elisa are specific and the most sensitive methods of measurement. There is a large intra-individual variability (25-60%) making it essential to repeat measurements always by the same technique. The prevalence of microalbuminuria is 5-8% in the general population and 6-24% in hypertensive patients. When present, it is a marker of increased cardiovascular risk. Clinical recommendations suggest adaptation of urinary collection according to the context: screening, diagnosis or clinical research. It is always necessary to start by dip-stick detection of proteinuria, haematuria or urinary infection. Clinical research requires repeated measurement of 24 hour microalbuminuria, sometimes divided into two periods of day and night, often associated with ambulatory blood pressure recordings and renal function tests. Studies of the effects of anti-hypertensive drugs on microalbuminuria could provide better evaluation. In conclusion, measurement of microalbuminuria remains a tool of clinical research allowing an assessment of cardiovascular and renal risk of hypertensive patients.

  12. [Metabolic abnormalities in young offsprings of parents with essential hypertension].

    PubMed

    Vicco, Miguel H; Rodeles, Luz; César, Lucía I; Ferini, Franco; Dorigo, Catalina; Musacchio, Héctor M

    2013-01-01

    The familiar history of hypertension in healthy young offsprings is associated with hyperinsulinemia, which could lead to increased serum cortisol, resulting in renal endothelial damage and the presence of microalbuminuria. The aim of this study was to evaluate, in healthy young offsprings of hypertensive parents, association between insulin levels, serum cortisol and microalbuminuria attending to its relationship with increased cardiovascular risk. We performed a cross-sectional correlational study in Santa Fe, Argentina, including 145 healthy individuals aged over 18 years, allocated to two groups: those with a history of essential hypertensive parents (study group) and those without such history (control group). We evaluated fasting serum insulin, cortisol, and microalbuminuria levels in the first morning urine. The mean age was 20 ± 2.9 years, and 58% were women. The study group included 48% (n = 69) of the sample. 4.8% had insulin resistance, microalbuminuria 13.8% and 52% hipercortisolinemia, with no significant differences in serum insulin, cortisol, or microalbuminuria between groups. No correlation was found between these variables. In this study there was no association between a history of first degree hypertension and impaired insulin or cortisol homoeostasis.

  13. Zinc and Diabetic Retinopathy

    PubMed Central

    Miao, Xiao; Sun, Weixia; Miao, Lining; Fu, Yaowen; Wang, Yonggang; Su, Guanfang; Liu, Quan

    2013-01-01

    Zinc (Zn) is an important nutrient that is involved in various physiological metabolisms. Zn dyshomeostasis is often associated with various pathogeneses of chronic diseases, such as metabolic syndrome, diabetes, and related complications. Zn is present in ocular tissue in high concentrations, particularly in the retina and choroid. Zn deficiencies have been shown to affect ocular development, cataracts, age-related macular degeneration, and even diabetic retinopathy. However, the mechanism by which Zn deficiency increases the prevalence of diabetic retinopathy remains unclear. In addition, due to the negative effect of Zn deficiency on the eye, Zn supplementation should prevent diabetic retinopathy; however, limited available data do not always support this notion. Therefore, the goal of this paper was to summarize these pieces of available information regarding Zn prevention of diabetic retinopathy. Current theories and possible mechanisms underlying the role of Zn in the eye-related diseases are discussed. The possible factors that affect the preventive effect of Zn supplementation on diabetic retinopathy were also discussed. PMID:23671870

  14. Low-grade proteinuria and microalbuminuria in renal transplantation.

    PubMed

    Halimi, Jean-Michel

    2013-07-27

    Nephrotic-range proteinuria has been known for years to be associated with poor renal outcome. Newer evidence indicates that early (1-3 months after transplantation) low-grade proteinuria and microalbuminuria (1) provide information on the graft in terms of donor characteristics and ischemia/reperfusion injury, (2) may occur before the development of donor-specific antibodies, (3) predict the development of diabetes and cardiovascular events, and (4) are associated with reduced long-term graft and patient survivals. Low-grade proteinuria and microalbuminuria are also predictive of diabetes, cardiovascular morbidity, and death in nontransplanted populations, which may help us to understand the pathophysiology of low-grade proteinuria or microalbuminuria in renal transplantation. The impact of immunosuppressive medications, including mammalian target of rapamycin inhibitors, on graft survival is still discussed, and the effect on proteinuria is crucial to the debate. The fact that chronic allograft rejection may exist as early as 3 months after renal transplantation indicates that optimal management of low-grade proteinuria or microalbuminuria should occur very early after transplantation to improve long-term renal function and the overall outcome of renal transplant recipients. The presence of low-grade proteinuria or microalbuminuria early after transplantation must be taken into account to choose adequate immunosuppressive and antihypertensive medications. Limited information exists regarding the benefit of therapeutic interventions to reduce low-grade proteinuria or microalbuminuria. Whether renin angiotensin blockade results in optimal nephroprotection in patients with low-grade proteinuria or microalbuminuria is not proven, especially in the absence of chronic allograft nephropathy. Observational studies and randomized clinical trials yield conflicting results. Finally, randomized clinical trials are urgently needed.

  15. Association of Microalbuminuria with Metabolic Syndrome among Aged Population.

    PubMed

    Li, Xiao-Hong; Lin, Hai-Yan; Wang, Shu-Hua; Guan, Li-Ying; Wang, Yi-Bing

    2016-01-01

    Background. The impact of the various components of metabolic syndrome (MetS) on chronic kidney disease has been conflicting. We aim to investigate the association between MetS and microalbuminuria and identify the major contributing components of MetS that result in microalbuminuria in the Chinese aged population. Methods. A total of 674 adults aged 55-98 years (males: 266; mean age: 66.5 ± 7.5 years) were studied. MetS was defined by the 2004 Chinese Diabetes Society criteria and microalbuminuria by urine albumin-creatinine ratio (UACR) ≥3 mg/mmoL. Results. The prevalence of microalbuminuria was gradually increased with increasing number of MetS components (P < 0.05). In multivariate regression, after adjusting for age and sex, MetS was the strongest correlate of microalbuminuria (OR = 1.781, 95% CI = 1.226-2.587; P < 0.05) followed by the fasting plasma glucose (FPG) (OR = 1.217, 95% CI = 1.044-1.092; P < 0.05), systolic blood pressure (SBP) (OR = 1.011, 95% CI = 1.107-1.338; P < 0.05), and high-density lipoprotein cholesterol (HDL-C) (OR = 0.576, 95% CI = 0.348-0.953; P < 0.05). Conclusions. MetS is independently associated with microalbuminuria in the Chinese aged population. Elevated FPG is the most predominant component of metabolic syndrome associated with microalbuminuria followed by elevated SBP and reduced HDL-C.

  16. Metabolomics of Diabetic Retinopathy.

    PubMed

    Liew, Gerald; Lei, Zhou; Tan, Gavin; Joachim, Nichole; Ho, I-Van; Wong, Tien Y; Mitchell, Paul; Gopinath, Bamini; Crossett, Ben

    2017-09-23

    Metabolomics is the study of dysregulated metabolites in biological materials. We reviewed the use of the technique to elucidate the genetic and environmental factors that contribute to the development of diabetic retinopathy. With regard to metabolomic studies of diabetic retinopathy, the field remains in its infancy with few studies published to date and little replication of results. Vitreous and serum samples are the main tissues examined, and dysregulation in pathways such as the pentose phosphate pathway, arginine to proline pathway, polyol pathway, and ascorbic acidic pathways have been reported. Few studies have examined the metabolomic underpinnings of diabetic retinopathy. Further research is required to replicate findings to date and determine longitudinal associations with disease.

  17. Arginase in Retinopathy

    PubMed Central

    Narayanan, S. Priya; Rojas, Modesto; Suwanpradid, Jutamas; Toque, Haroldo A.; Caldwell, R. William; Caldwell, Ruth B.

    2013-01-01

    Ischemic retinopathies, such as diabetic retinopathy (DR), retinopathy of prematurity and retinal vein occlusion are a major cause of blindness in developed nations worldwide. Each of these conditions is associated with early neurovascular dysfunction. However, conventional therapies target clinically significant macula edema or neovascularization, which occur much later. Intraocular injections of anti-VEGF show promise in reducing retinal edema, but the effects are usually transient and the need for repeated injections increases the risk of intraocular infection. Laser photocoagulation can control pathological neovascularization, but may impair vision and in some patients the retinopathy continues to progress. Moreover, neither treatment targets early stage disease or promotes repair. This review examines the potential role of the ureahydrolase enzyme arginase as a therapeutic target for the treatment of ischemic retinopathy. Arginase metabolizes L-arginine to form proline, polyamines and glutamate. Excessive arginase activity reduces the L-arginine supply for nitric oxide synthase (NOS), causing it to become uncoupled and produce superoxide and less NO. Superoxide and NO react and form the toxic oxidant peroxynitrite. The catabolic products of polyamine oxidation and glutamate can induce more oxidative stress and DNA damage, both of which can cause cellular injury. Studies indicate that neurovascular injury during retinopathy is associated with increased arginase expression/activity, decreased NO, polyamine oxidation, formation of superoxide and peroxynitrite and dysfunction and injury of both vascular and neural cells. Furthermore, data indicate that the cytosolic isoform arginase I (AI) is involved in hyperglycemia-induced dysfunction and injury of vascular endothelial cells whereas the mitochondrial isoform arginase II (AII) is involved in neurovascular dysfunction and death following hyperoxia exposure. Thus, we postulate that activation of the arginase

  18. Arginase in retinopathy.

    PubMed

    Narayanan, S Priya; Rojas, Modesto; Suwanpradid, Jutamas; Toque, Haroldo A; Caldwell, R William; Caldwell, Ruth B

    2013-09-01

    Ischemic retinopathies, such as diabetic retinopathy (DR), retinopathy of prematurity and retinal vein occlusion are a major cause of blindness in developed nations worldwide. Each of these conditions is associated with early neurovascular dysfunction. However, conventional therapies target clinically significant macula edema or neovascularization, which occur much later. Intra-ocular injections of anti-VEGF show promise in reducing retinal edema, but the effects are usually transient and the need for repeated injections increases the risk of intraocular infection. Laser photocoagulation can control pathological neovascularization, but may impair vision and in some patients the retinopathy continues to progress. Moreover, neither treatment targets early stage disease or promotes repair. This review examines the potential role of the ureahydrolase enzyme arginase as a therapeutic target for the treatment of ischemic retinopathy. Arginase metabolizes l-arginine to form proline, polyamines and glutamate. Excessive arginase activity reduces the l-arginine supply for nitric oxide synthase (NOS), causing it to become uncoupled and produce superoxide and less NO. Superoxide and NO react and form the toxic oxidant peroxynitrite. The catabolic products of polyamine oxidation and glutamate can induce more oxidative stress and DNA damage, both of which can cause cellular injury. Studies indicate that neurovascular injury during retinopathy is associated with increased arginase expression/activity, decreased NO, polyamine oxidation, formation of superoxide and peroxynitrite and dysfunction and injury of both vascular and neural cells. Furthermore, data indicate that the cytosolic isoform arginase I (AI) is involved in hyperglycemia-induced dysfunction and injury of vascular endothelial cells whereas the mitochondrial isoform arginase II (AII) is involved in neurovascular dysfunction and death following hyperoxia exposure. Thus, we postulate that activation of the arginase

  19. Imaging in Diabetic Retinopathy

    PubMed Central

    Salz, David A.; Witkin, Andre J.

    2015-01-01

    While the primary method for evaluating diabetic retinopathy involves direct and indirect ophthalmoscopy, various imaging modalities are of significant utility in the screening, evaluation, diagnosis, and treatment of different presentations and manifestations of this disease. This manuscript is a review of the important imaging modalities that are used in diabetic retinopathy, including color fundus photography, fluorescein angiography, B-scan ultrasonography, and optical coherence tomography. The article will provide an overview of these different imaging techniques and how they can be most effectively used in current practice. PMID:25949070

  20. Sickle cell retinopathy.

    PubMed

    Mason, G; Scherrer, F

    1991-12-01

    Sickle cell retinopathy was described as early as 1930 and research has been ongoing as to the pathophysiology of the disease, its effects on the eye and successful treatment. Disease stages have been identified and treatment modalities have been established for each stage. Research results and case reports have been published in medical journals available to physicians; however, there are no identifiable publications applicable to the nursing skills required to deal with this disease. Ophthalmic nurses should be knowledgeable of the sickle cell diseases and specifically the resultant retinopathy.

  1. [Systemic arterial hypertension in child and adolescent].

    PubMed

    Rosas-Peralta, Martín; Medina-Concebida, Luz Elena; Borrayo-Sánchez, Gabriela; Madrid-Miller, Alejandra; Ramírez-Arias, Erick; Pérez-Rodríguez, Gilberto

    2016-01-01

    The epidemic of childhood obesity, the risk of developing left ventricular hypertrophy, and evidence of the early development of atherosclerosis in children would make the detection of and intervention in childhood hypertension important to reduce long-term health risks; however, supporting data are lacking. Secondary hypertension is more common in preadolescent children, with most cases caused by renal disease. Primary or essential hypertension is more common in adolescents and has multiple risk factors, including obesity and a family history of hypertension. Evaluation involves a through history and physical examination, laboratory tests, and specialized studies. Management is multifaceted. Nonpharmacologic treatments include weight reduction, exercise, and dietary modifications. Although the evidence of first line therapy for hypertension is still controversial, the recommendations for pharmacologic treatment are based on symptomatic hypertension, evidence of end-organ damage, stage 2 of hypertension, or stage 1 of hypertension unresponsive to lifestyle modifications, and hypertension with diabetes mellitus where is the search for microalbuminuria justified.

  2. Retinopathy of Prematurity.

    ERIC Educational Resources Information Center

    Trief, E.; And Others

    1989-01-01

    Retinopathy of prematurity (ROP) has increased due to a high incidence of premature, low birthweight infants. Stages of severity range from no visual damage to total blindness, and educational problems of ROP children parallel those of other visually impaired children, early intervention being crucial. Treatments are either pharmacological or…

  3. Retinopathy of Prematurity.

    ERIC Educational Resources Information Center

    Trief, E.; And Others

    1989-01-01

    Retinopathy of prematurity (ROP) has increased due to a high incidence of premature, low birthweight infants. Stages of severity range from no visual damage to total blindness, and educational problems of ROP children parallel those of other visually impaired children, early intervention being crucial. Treatments are either pharmacological or…

  4. Diabetic Retinopathy and Systemic Factors

    PubMed Central

    Frank, Robert N.

    2015-01-01

    Diabetic retinopathy, an oculardisease, is governed by systemic as well as local ocular factors. These include primarily chronic levels of blood glucose. Individuals with chronically elevated blood glucose levels have substantially more, and more severe, retinopathy than those with lower blood glucose levels. The relationship of blood glucose to retinopathy is continuous, with no threshold although individuals with hemoglobin A1c levels (a measure of chronic glycemia) <6.5%, generally develop little or no retinopathy. Blood pressure levels have been claimed to influence retinopathy development and progression, but multiple controlled clinical trials of antihypertensive agents in diabetic subjects have produced only weak evidence of benefit from blood pressure lowering on the incidence and progression of diabetic retinopathy. Elevated blood lipids seem to play a role in the progression of retinopathy, and two trials of fenofibrate, a lipid-lowering agent that has not proved effective in preventing cardiovascular disease, have shown benefit in preventing retinopathy progression. The mechanism of this effect may not, however, be directly related to the reduction in blood lipids. Finally, there is strong, but only circumstantial, evidence for a genetic or epigenetic influence on the pathogenesis of diabetic retinopathy. Despite the power of large-scale epidemiologic studies and modern molecular biological and computational techniques, the gene or genes, which predispose or protect against the development and progression of diabetic retinopathy remain elusive. PMID:25949071

  5. Diabetic retinopathy and systemic factors.

    PubMed

    Frank, Robert N

    2015-01-01

    Diabetic retinopathy, an oculardisease, is governed by systemic as well as local ocular factors. These include primarily chronic levels of blood glucose. Individuals with chronically elevated blood glucose levels have substantially more, and more severe, retinopathy than those with lower blood glucose levels. The relationship of blood glucose to retinopathy is continuous, with no threshold although individuals with hemoglobin A1c levels (a measure of chronic glycemia) <6.5%, generally develop little or no retinopathy. Blood pressure levels have been claimed to influence retinopathy development and progression, but multiple controlled clinical trials of antihypertensive agents in diabetic subjects have produced only weak evidence of benefit from blood pressure lowering on the incidence and progression of diabetic retinopathy. Elevated blood lipids seem to play a role in the progression of retinopathy, and two trials of fenofibrate, a lipid-lowering agent that has not proved effective in preventing cardiovascular disease, have shown benefit in preventing retinopathy progression. The mechanism of this effect may not, however, be directly related to the reduction in blood lipids. Finally, there is strong, but only circumstantial, evidence for a genetic or epigenetic influence on the pathogenesis of diabetic retinopathy. Despite the power of large-scale epidemiologic studies and modern molecular biological and computational techniques, the gene or genes, which predispose or protect against the development and progression of diabetic retinopathy remain elusive.

  6. Blood pressure control for diabetic retinopathy

    PubMed Central

    Do, Diana V; Wang, Xue; Vedula, Satyanarayana S; Marrone, Michael; Sleilati, Gina; Hawkins, Barbara S; Frank, Robert N

    2015-01-01

    Background Diabetic retinopathy is a common complication of diabetes and a leading cause of visual impairment and blindness. Research has established the importance of blood glucose control to prevent development and progression of the ocular complications of diabetes. Simultaneous blood pressure control has been advocated for the same purpose, but findings reported from individual studies have supported varying conclusions regarding the ocular benefit of interventions on blood pressure. Objectives The primary aim of this review was to summarize the existing evidence regarding the effect of interventions to control or reduce blood pressure levels among diabetics on incidence and progression of diabetic retinopathy, preservation of visual acuity, adverse events, quality of life, and costs. A secondary aim was to compare classes of anti-hypertensive medications with respect to the same outcomes. Search methods We searched a number of electronic databases including CENTRAL as well as ongoing trial registries. We last searched the electronic databases on 25 April 2014. We also reviewed reference lists of review articles and trial reports selected for inclusion. In addition, we contacted investigators of trials with potentially pertinent data. Selection criteria We included in this review randomized controlled trials (RCTs) in which either type 1 or type 2 diabetic participants, with or without hypertension, were assigned randomly to intense versus less intense blood pressure control, to blood pressure control versus usual care or no intervention on blood pressure, or to different classes of anti-hypertensive agents versus placebo. Data collection and analysis Pairs of review authors independently reviewed titles and abstracts from electronic and manual searches and the full text of any document that appeared to be relevant. We assessed included trials independently for risk of bias with respect to outcomes reported in this review. We extracted data regarding trial

  7. Impact of the PPAR-γ2 Pro12Ala Polymorphism and ACE Inhibitor Therapy on New-Onset Microalbuminuria in Type 2 Diabetes: Evidence From BENEDICT

    PubMed Central

    De Cosmo, Salvatore; Motterlini, Nicola; Prudente, Sabrina; Pellegrini, Fabio; Trevisan, Roberto; Bossi, Antonio; Remuzzi, Giuseppe; Trischitta, Vincenzo; Ruggenenti, Piero

    2009-01-01

    OBJECTIVE Cross-sectional studies found less microalbuminuria in type 2 diabetic patients with the Ala12 allele of the peroxisome proliferator–activated receptor-γ2 (PPAR-γ2) Pro12Ala polymorphism. We prospectively evaluated the association between Pro12Ala polymorphism (rs1801282) and new-onset microalbuminuria. RESEARCH DESIGN AND METHODS Pro12Ala polymorphism was genotyped by TaqMan-based assay in genomic DNA of 1,119 consenting patients from BErgamo NEphrologic DIabetic Complications Trial (BENEDICT)—a prospective, randomized trial evaluating ACE inhibition effect on new-onset microalbuminuria (albuminuria 20–200 μg/min in at least two of three consecutive overnight urine collections in two consecutive visits) in hypertensive type 2 diabetes with albuminuria <20 μg/min at inclusion. RESULTS Baseline characteristics of Ala (Ala/Ala or Ala/Pro) carriers and Pro/Pro homozygotes were similar, with a nonsignificant trend to lower albuminuria (P = 0.1107) in the 177 Ala carriers. Over a median (interquartile range) of 44.0 (17.1–51.9) months, 7 (4%) Ala carriers and 86 (9.1%) Pro/Pro homozygotes developed microalbuminuria (hazard ratio [HR] 0.45 [95% CI 0.21–0.97]; P = 0.042). Final albuminuria was significantly lower in Ala carriers than Pro/Pro homozygotes (7.3 ± 9.1 vs. 10.5 ± 24.9 μg/min, respectively), even after adjustment for baseline albuminuria (P = 0.048). Baseline and follow-up blood pressure and metabolic control were similar in both groups. Incidence of microalbuminuria was significantly decreased by ACE versus non-ACE inhibitor therapy in Pro/Pro homozygotes (6.3 vs. 11.9%, respectively, HR 0.46 [0.29–0.72]; P < 0.001). CONCLUSIONS In type 2 diabetes, the Ala allele protects from worsening albuminuria and new-onset microalbuminuria, and ACE inhibition blunts the excess risk of microalbuminuria associated with the Pro/Pro genotype. Evaluating Pro12Ala polymorphism may help identifying patients at risk who may benefit the most from

  8. Impact of the PPAR-gamma2 Pro12Ala polymorphism and ACE inhibitor therapy on new-onset microalbuminuria in type 2 diabetes: evidence from BENEDICT.

    PubMed

    De Cosmo, Salvatore; Motterlini, Nicola; Prudente, Sabrina; Pellegrini, Fabio; Trevisan, Roberto; Bossi, Antonio; Remuzzi, Giuseppe; Trischitta, Vincenzo; Ruggenenti, Piero

    2009-12-01

    Cross-sectional studies found less microalbuminuria in type 2 diabetic patients with the Ala12 allele of the peroxisome proliferator-activated receptor-gamma2 (PPAR-gamma2) Pro12Ala polymorphism. We prospectively evaluated the association between Pro12Ala polymorphism (rs1801282) and new-onset microalbuminuria. Pro12Ala polymorphism was genotyped by TaqMan-based assay in genomic DNA of 1,119 consenting patients from BErgamo NEphrologic DIabetic Complications Trial (BENEDICT)-a prospective, randomized trial evaluating ACE inhibition effect on new-onset microalbuminuria (albuminuria 20-200 microg/min in at least two of three consecutive overnight urine collections in two consecutive visits) in hypertensive type 2 diabetes with albuminuria <20 microg/min at inclusion. Baseline characteristics of Ala (Ala/Ala or Ala/Pro) carriers and Pro/Pro homozygotes were similar, with a nonsignificant trend to lower albuminuria (P = 0.1107) in the 177 Ala carriers. Over a median (interquartile range) of 44.0 (17.1-51.9) months, 7 (4%) Ala carriers and 86 (9.1%) Pro/Pro homozygotes developed microalbuminuria (hazard ratio [HR] 0.45 [95% CI 0.21-0.97]; P = 0.042). Final albuminuria was significantly lower in Ala carriers than Pro/Pro homozygotes (7.3 +/- 9.1 vs. 10.5 +/- 24.9 microg/min, respectively), even after adjustment for baseline albuminuria (P = 0.048). Baseline and follow-up blood pressure and metabolic control were similar in both groups. Incidence of microalbuminuria was significantly decreased by ACE versus non-ACE inhibitor therapy in Pro/Pro homozygotes (6.3 vs. 11.9%, respectively, HR 0.46 [0.29-0.72]; P < 0.001). In type 2 diabetes, the Ala allele protects from worsening albuminuria and new-onset microalbuminuria, and ACE inhibition blunts the excess risk of microalbuminuria associated with the Pro/Pro genotype. Evaluating Pro12Ala polymorphism may help identifying patients at risk who may benefit the most from early renoprotective therapy.

  9. Inflammation in Diabetic Retinopathy

    PubMed Central

    Tang, Johnny; Kern, Timothy S.

    2012-01-01

    Diabetes causes a number of metabolic and physiologic abnormalities in the retina, but which of these abnormalities contribute to recognized features of diabetic retinopathy (DR) is less clear. Many of the molecular and physiologic abnormalities that have been found to develop in the retina in diabetes are consistent with inflammation. Moreover, a number of anti-inflammatory therapies have been found to significantly inhibit development of different aspects of DR in animal models. Herein, we review the inflammatory mediators and their relationship to early and late DR, and discuss the potential of anti-inflammatory approaches to inhibit development of different stages of the retinopathy. We focus primarily on information derived from in vivo studies, supplementing with information from in vitro studies were important. PMID:21635964

  10. Association of prediabetes-associated single nucleotide polymorphisms with microalbuminuria.

    PubMed

    Choi, Jong Wook; Moon, Shinje; Jang, Eun Jung; Lee, Chang Hwa; Park, Joon-Sung

    2017-01-01

    Increased glycemic exposure, even below the diagnostic criteria for diabetes mellitus, is crucial in the pathogenesis of diabetic microvascular complications represented by microalbuminuria. Nonetheless, there is limited evidence regarding which single nucleotide polymorphisms (SNPs) are associated with prediabetes and whether genetic predisposition to prediabetes is related to microalbuminuria, especially in the general population. Our objective was to answer these questions. We conducted a genomewide association study (GWAS) separately on two population-based cohorts, Ansung and Ansan, in the Korean Genome and Epidemiology Study (KoGES). The initial GWAS was carried out on the Ansung cohort, followed by a replication study on the Ansan cohort. A total of 5682 native Korean participants without a significant medical illness were classified into either control group (n = 3153) or prediabetic group (n = 2529). In the GWAS, we identified two susceptibility loci associated with prediabetes, one at 17p15.3-p15.1 in the GCK gene and another at 7p15.1 in YKT6. When variations in GCK and YKT6 were used as a model of prediabetes, this genetically determined prediabetes increased microalbuminuria. Multiple logistic regression analyses revealed that fasting glucose concentration in plasma and SNP rs2908289 in GCK were associated with microalbuminuria, and adjustment for age, gender, smoking history, systolic blood pressure, waist circumference, and serum triglyceride levels did not attenuate this association. Our results suggest that prediabetes and the associated SNPs may predispose to microalbuminuria before the diagnosis of diabetes mellitus. Further studies are needed to explore the details of the physiological and molecular mechanisms underlying this genetic association.

  11. Association of prediabetes-associated single nucleotide polymorphisms with microalbuminuria

    PubMed Central

    Choi, Jong Wook; Moon, Shinje; Jang, Eun Jung; Lee, Chang Hwa; Park, Joon-Sung

    2017-01-01

    Increased glycemic exposure, even below the diagnostic criteria for diabetes mellitus, is crucial in the pathogenesis of diabetic microvascular complications represented by microalbuminuria. Nonetheless, there is limited evidence regarding which single nucleotide polymorphisms (SNPs) are associated with prediabetes and whether genetic predisposition to prediabetes is related to microalbuminuria, especially in the general population. Our objective was to answer these questions. We conducted a genomewide association study (GWAS) separately on two population-based cohorts, Ansung and Ansan, in the Korean Genome and Epidemiology Study (KoGES). The initial GWAS was carried out on the Ansung cohort, followed by a replication study on the Ansan cohort. A total of 5682 native Korean participants without a significant medical illness were classified into either control group (n = 3153) or prediabetic group (n = 2529). In the GWAS, we identified two susceptibility loci associated with prediabetes, one at 17p15.3-p15.1 in the GCK gene and another at 7p15.1 in YKT6. When variations in GCK and YKT6 were used as a model of prediabetes, this genetically determined prediabetes increased microalbuminuria. Multiple logistic regression analyses revealed that fasting glucose concentration in plasma and SNP rs2908289 in GCK were associated with microalbuminuria, and adjustment for age, gender, smoking history, systolic blood pressure, waist circumference, and serum triglyceride levels did not attenuate this association. Our results suggest that prediabetes and the associated SNPs may predispose to microalbuminuria before the diagnosis of diabetes mellitus. Further studies are needed to explore the details of the physiological and molecular mechanisms underlying this genetic association. PMID:28158221

  12. Value of retinal examination in hypertensive encephalopathy.

    PubMed

    Amraoui, F; van Montfrans, G A; van den Born, B J H

    2010-04-01

    The presence of grade III or IV hypertensive retinopathy (HRP) is considered to distinguish hypertensive urgencies from emergencies. However, case-reports suggest that these retinal changes may be lacking in patients with hypertensive encephalopathy. To assess the frequency of grade III and IV retinopathy in this hypertensive emergency, we conducted a retrospective cohort study. We retrieved 162 patients with malignant hypertension and 34 patients (17%) fulfilled the predefined criteria for hypertensive encephalopathy. Data on retinal examination were incomplete for 6 patients (18%), thus leaving 28 patients who were analysed for the presence or absence of grade III and IV HRP. In 9 (32%) patients with hypertensive encephalopathy, grade III or IV HRP was absent, 11 (39%) patients presented with grade III and 8 (29%) patients with grade IV retinopathy. Patients without retinal abnormalities were on average 13 years younger (P=0.05), more often black (P=0.02) and displayed lower blood pressure (BP) values (P=0.04 for systolic and diastolic BP). A substantial proportion of patients with hypertensive encephalopathy lack grade III or IV HRP. This suggests that the decision to admit these patients should not only rely on the presence of grade III and IV retinopathy alone, but should also include a careful neurological examination.

  13. Early Treatment With Olmesartan Prevents Juxtamedullary Glomerular Podocyte Injury and the Onset of Microalbuminuria in Type 2 Diabetic Rats

    PubMed Central

    Sofue, Tadashi; Kiyomoto, Hideyasu; Kobori, Hiroyuki; Urushihara, Maki; Nishijima, Yoko; Kaifu, Kumiko; Hara, Taiga; Matsumoto, Sachiko; Ichimura, Atsuhiko; Ohsaki, Hiroyuki; Hitomi, Hirofumi; Kawachi, Hiroshi; Hayden, Melvin R.; Whaley-Connell, Adam; Sowers, James R.; Ito, Sadayoshi; Kohno, Masakazu; Nishiyama, Akira

    2012-01-01

    Background Studies were performed to determine if early treatment with an angiotensin II (Ang II) receptor blocker (ARB), olmesartan, prevents the onset of microalbuminuria by attenuating glomerular podocyte injury in Otsuka Long-Evans Tokushima Fatty (OLETF) rats with type 2 diabetes mellitus. Methods OLETF rats were treated with either a vehicle, olmesartan (10 mg/kg/day) or a combination of nonspecific vasodilators (hydralazine 15 mg/kg/day, hydrochlorothiazide 6 mg/kg/day, and reserpine 0.3 mg/kg/day; HHR) from the age of 7–25 weeks. Results OLETF rats were hypertensive and had microalbuminuria from 9 weeks of age. At 15 weeks, OLETF rats had higher Ang II levels in the kidney, larger glomerular desmin-staining areas (an index of podocyte injury), and lower gene expression of nephrin in juxtamedullary glomeruli, than nondiabetic Long-Evans Tokushima Otsuka (LETO) rats. At 25 weeks, OLETF rats showed overt albuminuria, and higher levels of Ang II in the kidney and larger glomerular desmin-staining areas in superficial and juxtamedullary glomeruli compared to LETO rats. Reductions in mRNA levels of nephrin were also observed in superficial and juxtamedullary glomeruli. Although olmesartan did not affect glucose metabolism, it decreased blood pressure and prevented the renal changes in OLETF rats. HHR treatment also reduced blood pressure, but did not affect the renal parameters. Conclusions This study demonstrated that podocyte injury occurs in juxtamedullary glomeruli prior to superficial glomeruli in type 2 diabetic rats with microalbuminuria. Early treatment with an ARB may prevent the onset of albuminuria through its protective effects on juxtamedullary glomerular podocytes. PMID:22318512

  14. Screening for diabetic microalbuminuria in routine clinical care: which method?

    PubMed Central

    Shield, J P; Hunt, L P; Baum, J D; Pennock, C A

    1995-01-01

    The measurement of albumin/creatinine ratios and simple albumin concentrations in early morning urine specimens were evaluated to establish which was the best screening test for those likely to have microalbuminuria by the reference standard analysis of timed overnight urine specimens. The measurement of an albumin/creatinine ratio with a cut off of > or = 2.0 mg/mmol was found to be suitable with a specificity of 93% and sensitivity of 97%. PMID:7618940

  15. Factors associated with remission and/or regression of microalbuminuria in type 2 diabetes mellitus.

    PubMed

    Ono, Tetsuichiro; Shikata, Kenichi; Obika, Mikako; Miyatake, Nobuyuki; Kodera, Ryo; Hirota, Daisyo; Wada, Jun; Kataoka, Hitomi; Ogawa, Daisuke; Makino, Hirofumi

    2014-01-01

    The aim of this study was to clarify the factors associated with the remission and/or regression of microalbuminuria in Japanese patients with type 2 diabetes mellitus. We retrospectively analyzed the data of 130 patients with type 2 diabetes mellitus with microalbuminuria for 2-6 years (3.39±1.31 years). Remission was defined as improving from microalbuminuria to normoalbuminuria using the albumin/creatinine ratio (ACR), and regression of microalbuminuria was defined as a decrease in ACR of 50% or more from baseline. Progression of microalbuminuria was defined as progressing from microalbuminuria to overt proteinuria during the follow-up period. Among 130 patients with type 2 diabetes mellitus with microalbuminuria, 57 and 13 patients were defined as having remission and regression, respectively, while 26 patients progressed to overt proteinuria. Sex (female), higher HDL cholesterol and lower HbA1c were determinant factors associated with remission/regression of microalbuminuria by logistic regression analysis. Lower systolic blood pressure (SBP) was also correlated with remission/regression, but not at a significant level. These results suggest that proper control of blood glucose, BP and lipid profiles may be associated with remission and/or regression of type 2 diabetes mellitus with microalbuminuria in clinical practice.

  16. The retinal renin-angiotensin system: implications for therapy in diabetic retinopathy.

    PubMed

    Sjølie, A K; Chaturvedi, N

    2002-08-01

    Retinopathy is the most common complication of diabetes, and a leading cause of blindness in people of working age. Optimal blood pressure and metabolic control can reduce the risk of diabetic retinopathy, but are difficult to achieve in clinical practice. In the EUCLID Study, the angiotensin converting enzyme (ACE) inhibitor lisinopril reduced the risk of progression of retinopathy by approximately 50%, and also significantly reduced the risk of progression to proliferative retinopathy. These findings are consistent with extensive evidence that the renin-angiotensin system is expressed in the eye, and that adverse effects of angiotensin II on retinal angiogenesis and function can be inhibited by ACE inhibitors or angiotensin II-receptor blockers. However, in the EUCLID Study retinopathy was not a primary end-point and the study was not sufficiently powered for the eye-related outcomes. Hence, the Diabetic Retinopathy Candesartan Trials (DIRECT) programme has been established to determine whether AT(1)-receptor blockade with candesartan can prevent the incidence and progression of diabetic retinopathy. This programme comprises three studies, involving a total of 4500 patients recruited from about 300 centres worldwide. The patients are normotensive or treated hypertensive individuals, and so the DIRECT programme should assess the potential of an AT(1)-receptor blocker to protect against the pathological changes in the eye following diabetes.

  17. Prevalence and determinants of microalbuminuria among diabetic patients in the United Arab Emirates

    PubMed Central

    Al-Maskari, Fatma; El-Sadig, Mohammed; Obineche, Enyioma

    2008-01-01

    Background Microalbuminuria (MA) represents the earliest clinical evidence of diabetic nephropathy and is a predictor of increased cardiovascular morbidity and mortality. The aim of this study was to determine the prevalence of MA among diabetic patients in the Al-Ain district of the United Arab Emirates (UAE). Methods The study was part of a general cross-sectional survey carried out to assess the prevalence of diabetes mellitus (DM) complications in Al-Ain district, UAE and was the first to assess the prevalence of MA among diabetic patients. A sample of 513 diabetic patients with a mean age of 53 years (SD: ± 13) was randomly selected during 2003/2004. All patients completed an interviewer-administered questionnaire and underwent medical assessment. First morning urine collections were obtained and were tested for clinical proteinuria using urine dipsticks and for MA using the single Micral-Test II strips. Results MA was found in 61% (95% CI: 56.7–65.7) of the sample and the rate was significantly higher among males, positively related to body mass index (BMI), type 2 DM and presence of other DM complications such as diabetic retinopathy and neuropathy. Of the total sample population, 12.5% (95% CI: 8.1-14.1) had clinical proteinuria. Conclusion The prevalence rate of MA was considerably high ( 61%) among diabetic patients in the UAE. Therefore, regular screening for MA is recommended for all diabetic patients, as early treatment is critical for reducing cardiovascular risks and slowing the progression to late stages of diabetic nephropathy (overt proteinuria and end-stage renal disease). PMID:18230135

  18. The relationship of mean platelet volume with retinopathy in type 2 diabetes mellitus.

    PubMed

    Güngör, Aslı Araz; Gürsoy, Gül; Güngör, Fatih; Bayram, Seyit Murat; Atalay, Eray

    2016-11-17

    Patients with diabetes mellitus have an increased risk of developing micro- and macrovascular complications. Retinopathy is one of the most important complications of diabetes whose pathophysiological cause has not yet been determined. One candidate may be platelet volume. In this study we aimed to investigate the association between mean platelet volume and diabetic retinopathy. Mean platelet volume levels were investigated in type 2 diabetic patients with and without retinopathy, and in healthy participants. After reclassifying our diabetics in terms of the presence or absence of hypertension and hyperlipidemia, we compared their mean platelet volumes. We then checked to see if the mean platelet volume correlated with hemoglobin A1c and body mass index. The mean platelet volume levels were higher in all diabetic patients, and they were highest in diabetics with retinopathy. The mean platelet volume levels were not different in diabetic patients with and without hypertension or hyperlipidemia. Moreover, the mean platelet volume levels did not correlate with hemoglobin A1c or body mass index. We think that platelets may play a role in diabetic retinopathy. We can also say that, in diabetic patients, hypertension, hyperlipemia, obesity, and control of diabetes were not related to mean platelet volume.

  19. Autosomal recessive pericentral pigmentary retinopathy.

    PubMed

    Traboulsi, E I; O'Neill, J F; Maumenee, I H

    1988-11-15

    A brother and sister, born to consanguineous parents, had pigmentary retinopathy in a pericentral distribution. The retinopathy was noted in infancy when the siblings were examined for strabismus. The optic disks, maculae, and retinal vessels were normal. There was mild reduction in amplitude of both scotopic and photopic electroretinographic responses. Both patients had moderate hyperopic astigmatism and esotropia. The fundus and visual acuity remained unchanged over periods of nine and 13 years in the brother and sister, respectively. Results of ocular examinations on the father, mother, and an older sister were normal. These findings support an autosomal recessive mode of inheritance in this family with pericentral pigmentary retinopathy.

  20. Similarities and differences in early retinal phenotypes in hypertension and diabetes.

    PubMed

    Grosso, Andrea; Cheung, Ning; Veglio, Franco; Wong, Tien Yin

    2011-09-01

    The use of retinal photography in clinical practice and research has substantially increased the knowledge about the epidemiology, natural history and significance of diabetic and hypertensive retinopathy. Early retinopathy signs, including retinal microaneurysms, blot hemorrhages, cotton-wool spots and hard exudates, are common vascular abnormalities found in middle-aged to older people with diabetes and hypertension. The presence of these early retinopathy signs is associated with an increased risk of systemic vascular diseases, such as stroke, cognitive impairment, coronary heart disease, heart failure and nephropathy. These retinopathy lesions may therefore be considered as biomarkers of systemic microvascular processes caused by diabetes and hypertension. Nevertheless, whereas the interest in retinopathy assessment continues to grow, a core concept remains undefined: what is the relative importance and contribution of diabetes and hypertension in the development of early retinopathy signs? The answer of this fundamental question holds the key to better understanding of the systemic associations of early hypertensive and diabetic retinopathy. In this review, we summarize the similarities and differences of early retinopathy signs seen in diabetes and hypertension, and discuss the conceptual relevance from epidemiological, pathophysiological, and clinical perspectives.

  1. Association of Urinary Activity of MMP-2 with Microalbuminuria in an Isolated Sample of Subjects Living in High Altitude Rural Locations in México.

    PubMed

    Hernández-Hernández, Magda Elena; Morales-Romero, Jaime; Sampieri, Clara Luz; Luna Lozano, Diego Jesús; Valencia Lezama, Isidra Del Carmen; Muñoz Contreras, Mónica Janett; Rodríguez Hernández, Arturo

    2017-09-01

    Hernández-Hernández, Magda Elena, Jaime Morales-Romero, Clara Luz Sampieri, Diego Jesús Luna Lozano, Isidra del Carmen Valencia Lezama, Mónica Janett Muñoz Contreras, and Arturo Rodríguez Hernández. Association of urinary activity of MMP-2 with microalbuminuria in an isolated sample of subjects living in high altitude rural locations in México. High Alt Med Biol. 18:209-218, 2017.-Matrix metalloproteinases (MMP) are implicated in remodeling of the renal extracellular matrix. In a cross-sectional study we evaluated renal impairment in general population of high-altitude rural locations in México. Multivariable analysis was performed to identify the association between MMP-2 and MMP-9 and microalbuminuria. Twenty-eight (20.9%) subjects with renal impairment (WRI) and 106 (79.1%) without renal impairment were included. No differences were found relating to sex, location, marital status, current habits, weight, height, body mass index, waist size in males, creatinine in males, and uric acid. In contrast, differences were found among age, level of education, waist size in general and in females, creatinine in general and in females, urinary albumin, urea, glucose, total cholesterol, and triglycerides. Proportions of hypertension, type 2 diabetes mellitus, central abdominal obesity, hypertriglyceridemia, and hypercholesterolemia were greater in the group WRI. Presence of urinary MMP-2 or of both urinary gelatinases and arbitrary unit (AU) values ≥P90 were associated with microalbuminuria. We conclude that AU values ≥P90 of urinary MMP-2 (OR = 20.1, p = 0.002) is associated with microalbuminuria.

  2. Prevalence of microalbuminuria in relation to glycemic control in type-2 diabetic patients in Mymensingh.

    PubMed

    Hasan, M J; Muqueet, A; Sharmeen, A; Hoque, M R

    2015-01-01

    Microalbuminuria is a renal marker of generalized vascular endothelial damage and early atherosclerosis. Patients with microalbuminuria are at increased risk of microvascular and macrovascular complications of diabetes mellitus like myocardial infarction, stroke and nephropathy. Poor glycemic control increases the risk of microalbuminuria. This study was conducted to determine the frequency of microalbuminuria in type 2 diabetes and compare the frequency of microalbuminuria in poor and good glycemic control in type 2 diabetes. One Hundred and twenty two type 2 diabetic patients were included in the study. Data on age, gender, duration of diabetes, microalbuminuria and HbA1c were recorded. Urine and blood samples were collected and analyzed for microalbuminuria, blood glucose and HbA1c. All patients of both genders with type 2 diabetes for over 2 years were selected in this study. Patients with other causes of proteinuria were excluded. Out of 120 cases 93(77.5%) were male and 27(22.5%) were female. Mean age of patients was 57.8±14.7 years and average duration of diabetes was 9.2 years. Microalbuminuria was found 76.9% of male and 23.1% of female. Patients with poor glycemic control and good glycemic control have frequency of microalbuminuria of 55% and 54% respectively. Uncontrolled diabetes is strongly associated with prevalence of microalbuminuria. Screening for microalbuminuria and HbA1c test should be done both in newly and already diagnosed type 2 diabetic patients as an early marker of renal dysfunction and glycemic control.

  3. Clinical associations between metabolic syndrome and the development of microalbuminuria in Korean men.

    PubMed

    Ryoo, Jae-Hong; Chun, Hyejin; Lee, Hong-Soo; Suh, Eunkyung; Choi, Joong-Myung; Kim, Min-Gi; Shin, HoCheol; Park, Sung Keun; Oh, Chang-Mo; Ko, Taeg Su

    2015-03-01

    There have been several studies on the association between metabolic syndrome (MetS) and microalbuminuria. However, none has examined whether MetS is associated with the prospective development of microalbuminuria. Accordingly, we performed a prospective study to evaluate the longitudinal effects of baseline number of MetS traits on the development of microalbuminuria in Korean men. 1649 Korean men without microalbuminuria in 2005 were included and followed prospectively until 2010 with the endpoint being the development of microalbuminuria. MetS was defined according to the joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention. Microalbuminuria was evaluated by urine albumin creatinine ratio (UACR). Risk estimations for development of microalbuminuria were analyzed according to the number of MetS traits using multivariate adjusted Cox proportional hazards model. During 5611.8 person-years of follow-up (median 3.40±1.46 years), microalbuminuria developed in 91 (5.5%) participants between 2006 and 2010. After adjusting for multiple covariates, the hazard ratios (95% confidence interval) for development of microalbuminuria comparing 1, 2 and 3-5 MetS traits vs 0 were 2.57 (0.97-6.82), 2.94 (1.09-7.98) and 3.85 (1.37-10.86), respectively. The number of MetS traits independently associated with the future development of microalbuminuria during the 5-year follow-up period, and MetS per se was an independent risk factor for microalbuminuria. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  4. A story of microalbuminuria and diabetic nephropathy

    PubMed Central

    Roshan, Bijan; Stanton, Robert C.

    2013-01-01

    Context: It is estimated that more than 346 million people worldwide have diabetes mellitus . By the year 2030, it is predicted that diabetes will become the seventh leading cause of death in the world. Development of chronic kidney disease (CKD) in patients with diabetes adds significantly to the morbidity and mortality and significantly increases health care costs, even before the development of end stage renal disease (ESRD). Evidence  acquisitions: Directory of Open Access Journals (DOAJ), Google Scholar, Pubmed (NLM), LISTA (EBSCO) and Web of Science have been searched. Results: Diabetic nephropathy (DN) is increasing rapidly worldwide. It is the leading cause of new cases of ESRD in the USA.  Interestingly, although DN is the most common cause of ESRD in diabetic patients, diabetes mellitus is also an independent and strong risk factor for ESRD ascribed to causes other than DN (e.g. hypertensive nephropathy). Conclusions: It is important to be aware of the pitfalls of using the urine albumin level in predicting development and progression of diabetic nephropathy in order to treat and advise the patients accurately.  Research into finding new markers is rapidly evolving but current progress makes it likely we will be using the urine albumin level for some years into the future. PMID:24475455

  5. A story of microalbuminuria and diabetic nephropathy.

    PubMed

    Roshan, Bijan; Stanton, Robert C

    2013-10-01

    It is estimated that more than 346 million people worldwide have diabetes mellitus . By the year 2030, it is predicted that diabetes will become the seventh leading cause of death in the world. Development of chronic kidney disease (CKD) in patients with diabetes adds significantly to the morbidity and mortality and significantly increases health care costs, even before the development of end stage renal disease (ESRD). Evidence  acquisitions: Directory of Open Access Journals (DOAJ), Google Scholar, Pubmed (NLM), LISTA (EBSCO) and Web of Science have been searched. Diabetic nephropathy (DN) is increasing rapidly worldwide. It is the leading cause of new cases of ESRD in the USA.  Interestingly, although DN is the most common cause of ESRD in diabetic patients, diabetes mellitus is also an independent and strong risk factor for ESRD ascribed to causes other than DN (e.g. hypertensive nephropathy). It is important to be aware of the pitfalls of using the urine albumin level in predicting development and progression of diabetic nephropathy in order to treat and advise the patients accurately.  Research into finding new markers is rapidly evolving but current progress makes it likely we will be using the urine albumin level for some years into the future.

  6. [Microalbuminuria as a marker of endothelial dysfunction in the long-term follow-up patients after surgical correction of aortic coarctation].

    PubMed

    Volkova, N I; Lazoryshynets, V V

    2013-06-01

    1170 patients after surgical correction of aortic coarctation during the period from 1988 to 2002 were studied. The median period of medical supervision after coarctation repair was 13,8 years, maximum age - 24 years. For diagnostics of the Microalbuminuria (MAU) it were used the special test-strings Microalbu PHAN (PLIVA-Lachema Diagnostica). MAU were discovered in 62.6% of and 34.9% of normotesive patients. Credible decrease of MAU of hypertensive patients with corrected coarctation of the aorta were defined after 3 months-long treatment by Losartan.

  7. Familial central serous retinopathy.

    PubMed

    Oosterhuis, J A

    1996-05-01

    To study the familial occurrence of central serous retinopathy (CSR). We pooled data from eight eye clinics in Western Europe. We collected 11 families that each had two to four members with CSR. In 10 families siblings and in one family a mother and son were affected. Sixty percent of the patients were male and 40% female. CSR was found in 55 (92%) of 60 eyes, 44 (80%) showing a chronic course. In 25 patients (83%) both eyes were affected. Most recent visual acuity was 0.5 or less in 17 (39%) and 0.2 or less in 8 (18%) of the eyes with chronic CSR. Our findings of familial occurrence and a chronic disorder that is progressive, diffuse, and bilateral suggest an inborn disposition to develop a clinically manifest disintegration of the retinal pigment epithelium in adulthood.

  8. Solar retinopathy in children.

    PubMed

    Gregory-Roberts, Emily; Chen, Ye; Harper, C Alex; Ong, Terrence; Maclean, M Anne; Fagan, Xavier J; Carden, Susan M

    2015-08-01

    To describe the visual acuity, fundus appearance, and spectral domain optical coherence tomography (SD-OCT) findings in 5 eyes of 3 children with foveal damage from solar retinopathy. This was a prospective, observational case series of children who presented to the emergency department at the Royal Victorian Eye and Ear Hospital after having directly viewed the Sun during the transit of Venus on June 6, 2012, or the partial eclipse of the Sun on November 14, 2012. All patients underwent visual acuity testing, dilated fundus examination, and SD-OCT imaging. The 3 patients' ages at presentation were 8, 10, and 11 years. Best-corrected visual acuity in the affected eyes ranged from 20/20 to 20/40 on presentation. Significant foveal pathology was identified on SD-OCT in all 5 eyes, even when visual acuity was normal. At presentation, all eyes showed disruption of the photoreceptor ellipsoid zone and the interdigitation zone on SD-OCT. Additionally, in those eyes with decreased visual acuity, there was disruption of the outer nuclear layer and/or external limiting membrane. At 3-5 months' follow-up, the outer nuclear layer and external limiting membrane lesions had resolved; however, in some eyes the ellipsoid and interdigitation zone abnormalities persisted at 5 months' follow-up, even in the presence of best-corrected visual acuity as good as 20/12.5. Solar retinopathy in children can cause persistent damage to multiple retinal layers despite recovery of good visual acuity. Copyright © 2015 American Association for Pediatric Ophthalmology and Strabismus. Published by Elsevier Inc. All rights reserved.

  9. Central serous retinopathy complicating systemic lupus erythematosus: a case series.

    PubMed

    Khng, C G; Yap, E Y; Au-Eong, K G; Lim, T H; Leong, K H

    2000-08-01

    Systemic lupus erythematosus (SLE) is a chronic autoimmune disorder with widespread manifestations including the eye. Central serous retinopathy (CSR) has been associated as a complicating event in SLE, although it is uncommon. We present a case series of four female Chinese SLE patients who developed CSR during the course of their systemic disease. All four presented clinically with typical CSR. Angiographic findings did not show evidence of choroidal ischaemia or delayed choroidal filling. Resolution of the serous retinal detachment occurred in all four patients. Recovery of vision was seen in three patients. The clinical outcome was similar to that occurring in the usual male population. Central serous retinopathy as a manifestation of SLE may be caused by various factors. These include SLE-associated choroidopathy, systemic hypertension, renal disease, retinal pigment epithelial dysfunction and glucocorticoid therapy.

  10. Pulmonary hypertension

    MedlinePlus

    Pulmonary arterial hypertension; Sporadic primary pulmonary hypertension; Familial primary pulmonary hypertension; Idiopathic pulmonary arterial hypertension; Primary pulmonary hypertension; PPH; Secondary pulmonary ...

  11. Preventing radiation retinopathy with hyperfractionation

    SciTech Connect

    Monroe, Alan T.; Bhandare, Niranjan; Morris, Christopher G.; Mendenhall, William M. . E-mail: mendewil@shands.ufl.edu

    2005-03-01

    Purpose: The purpose of this study was to determine factors associated with the development of radiation retinopathy in a large series of patients with head-and-neck cancer. In particular, we addressed whether the use of hyperfractionated radiation therapy was effective in reducing the risk of retinopathy. Methods and materials: One hundred eighty-six patients received a significant dose to the retina as part of curative radiotherapy. Primary sites included: nasopharynx, 46; paranasal sinus, 64; nasal cavity, 69; and palate, 7. Prescription doses varied depending on primary site and histology. Hyperfractionated (twice-daily) radiation was delivered to 42% of the patients in this study, typically at 1.10 to 1.20 Gy per fraction. The remainder were treated once-daily. Retinal doses were determined from computerized dosimetry plans when available. For all other patients, retinal doses were retrospectively calculated using reconstructed off-axis dosimetry taken from contours through the center of the globes. Retinal dose was defined as the minimum dose received by at least 25% of the globe. The median retinal dose was 56.85 Gy. Patients were followed for a median of 7.6 years. Results: Thirty-one eyes in 30 patients developed radiation retinopathy, resulting in monocular blindness in 25, bilateral blindness in 1, and decreased visual acuity in 4. The median time to the diagnosis of retinopathy was 2.6 years (range, 11 months to 5.3 years). The actuarial incidence of developing radiation retinopathy was 20% at both 5 and 10 years. The incidence of developing ipsilateral blindness due to retinopathy was 16% at 5 years and 17% at 10 years. Site-specific incidences varied considerably, with ethmoid sinus (9 of 25, 36%), nasal cavity (13 of 69, 19%), and maxillary sinus (6 of 35, 17%) being the most common sites associated with radiation retinopathy. Three of 72 patients (4%) receiving retinal doses less than 50 Gy developed retinopathy. Higher retinal doses resulted in a

  12. Hypertensive pregnancy disorders and future renal disease.

    PubMed

    Wagner, Steven; Craici, Iasmina

    2014-10-01

    Hypertensive pregnancy disorders affect approximately 6 to 8 % of otherwise normal pregnancies. A growing body of evidence links these disorders with the future development of hypertension, coronary disease, cerebrovascular disease, and peripheral arterial disease. Larger studies associating hypertensive pregnancy to future development of renal disease have been lacking until recently, with publication of several compelling studies in the last 5 years. In this review, we will focus on the recent evidence associating hypertensive pregnancy disorders with the future development of chronic kidney disease (CKD) and end-stage renal disease (ESRD), as well as the development of microalbuminuria. We will also attempt to answer whether these renal risks are due to direct effects of hypertension during pregnancy, or whether they are due to shared environmental and genetic risk factors.

  13. [Could the expression of L-selectin be an early marker of arterial hypertension and microangiopathy in the course of type 1 diabetes mellitus in juvenile patients?].

    PubMed

    Pawłowski, Przemysław; Urban, Mirosława; Peczyńska, Jadwiga

    2005-01-01

    Autoreactive T lymphocytes participate in the development of type 1 diabetes mellitus. The migration of T cells is initiated by increased expression of L-selectin on the cellular membrane of lymphocyte. Recently, a correlation between the concentration of sL-selectin and the develop-ment of diabetic retinopathy, atherosclerosis and arterial hypertension was stated. The purpose of this study was to evaluate whether the expression of L-selectin on lymphocytes T alters in the course of the disease -- diabetes lasting less than 5 years and over 5 years; to assess a relationship between the percentage of L-selectin on T cells and the evolution of vascular complications; to elucidate whether the percentage of peripheral blood T lymphocytes expressing L-selectin could be an early marker of angiopathy in juvenile patients. The study was carried out on 60 children and adolescents (aged 9-20) with diagnosed type 1 diabetes: a) (20 n) with the disease lasting <5 years, b) (20 n) with type 1 diabetes lasting >5 years without vascular complications, c) (20 n) with type 1 diabetes and vascular complications (microalbuminuria, arterial hypertension, diabetic retinopathy). The control group consisted of 20 healthy volunteers (aged 6-17). The expression of adhesion molecules has been evaluated by using three-color flow cytometry (Coulter EPICS XL). HbA1c concentration has been analysed by a liquid chromatography technique HPLC-Variant (Bio-Rad). The percentage of T lymphocytes expressing L-selectin was significantly increased in all groups of patients with type 1 diabetes versus healthy controls (p<0.005 and p<0.001, in groups without complications and with angiopathy, respectively). Moreover in patients with diagnosed arterial hypertension the percentage of T lymphocytes expressing L-selectin was higher than in patients in whom arterial hypertension was not developed (p<0.05). In juvenile patients with type 1 diabetes the percentage of T lymphocytes expressing L-selectin was

  14. Scanning laser edema index: a reliable tool to correlate with diabetic retinopathy and systemic risk factors?

    PubMed

    Peyman, Mohammadreza; Tajunisah, Iqbal; Loo, Angela; Chuah, Khai Choon; Subrayan, Visvaraja

    2012-01-01

    To correlate Heidelberg Retina Tomograph (HRT) derived macular edema (DME) index with severity of diabetic retinopathy and systemic factors. A total of 300 diabetic patients were recruited for the study for each of them a value for the macular edema index was obtained using the HRT II. Patients' age, gender, duration and type of diabetes mellitus, latest HbA1c result and presence or absence of co-morbid factors (hypertension, ischemic heart disease, nephropathy) were recorded together with the stage of diabetic retinopathy. These were correlated with DME. Out of 300 patients, HRT defined macula edema was seen in 68 patients (22.6%). There is a wider and higher range (95% percentile) of macula edema index in the severe non proliferative diabetic retinopathy (NPDR) group. Independent samples t test showed significant difference between the severe NPDR group and no DR group (p<0.001), mild NPDR group (p<0.05) and moderate NPDR group (p<0.05). A higher macula edema index was also found to have a low degree of correlation with more advanced stages of retinopathy (r=0.310; p<0.001). Also nephropathy showed a strong and significant correlation with DME. Hypertension had moderately significant correlation with DME. This study found no correlation between ischemic heart disease and DME. HRT derived scanning laser edema index is a reliable objective tool to evaluate diabetic retinopathy and systemic risk factors.

  15. Insulin Pump Therapy Is Associated with Lower Rates of Retinopathy and Peripheral Nerve Abnormality

    PubMed Central

    Zabeen, Bedowra; Craig, Maria E.; Virk, Sohaib A.; Pryke, Alison; Chan, Albert K. F.; Cho, Yoon Hi; Benitez-Aguirre, Paul Z.; Hing, Stephen; Donaghue, Kim C.

    2016-01-01

    Objective To compare rates of microvascular complications in adolescents with type 1 diabetes treated with continuous subcutaneous insulin infusion (CSII) versus multiple daily injections (MDI). Research Design and Methods Prospective cohort of 989 patients (aged 12–20 years; diabetes duration >5 years) treated with CSII or MDI for >12 months. Microvascular complications were assessed from 2000–14: early retinopathy (seven-field fundal photography), peripheral nerve function (thermal and vibration threshold testing), autonomic nerve abnormality (heart rate variability analysis of electrocardiogram recordings) and albuminuria (albumin creatinine ratio/timed overnight albumin excretion). Generalized estimating equations (GEE) were used to examine the relationship between treatment and complications rates, adjusting for socio-economic status (SES) and known risk factors including HbA1c and diabetes duration. Results Comparing CSII with MDI: HbA1C was 8.6% [70mmol/mol] vs. 8.7% [72 mmol/mol]) (p = 0.7), retinopathy 17% vs. 22% (p = 0.06); microalbuminuria 1% vs. 4% (p = 0.07), peripheral nerve abnormality 27% vs. 33% (p = 0.108) and autonomic nerve abnormality 24% vs. 28% (p = 0.401). In multivariable GEE, CSII use was associated with lower rates of retinopathy (OR 0.66, 95% CI 0.45–0.95, p = 0.029) and peripheral nerve abnormality (OR 0.63, 95% CI 0.42–0.95, p = 0.026), but not albuminuria (OR 0.46, 95% CI 0.10–2.17, p = 0.33). SES was not associated with any of the complication outcomes. Conclusions In adolescents, CSII use is associated with lower rates of retinopathy and peripheral nerve abnormality, suggesting an apparent benefit of CSII over MDI independent of glycemic control or SES. PMID:27050468

  16. Malarial Retinopathy in Bangladeshi Adults

    PubMed Central

    Sayeed, Abdullah Abu; Maude, Richard J.; Hasan, Mahtab Uddin; Mohammed, Noor; Hoque, M. Gofranul; Dondorp, Arjen M.; Faiz, M. Abul

    2011-01-01

    To establish if assessment of malarial retinopathy in adult malaria using ophthalmoscopy by non-ophthalmologists has clinical and prognostic significance, 210 Bangladeshi adults were assessed by both direct and indirect ophthalmoscopy; 20 of 20 healthy subjects and 20 of 20 patients with vivax malaria showed no retinal changes, whereas in patients with falciparum malaria, indirect ophthalmoscopy revealed malarial retinopathy (predominantly retinal hemorrhages) in 18 of 21 (86%) fatal, 31 of 75 (41%) cerebral, 16 of 64 (25%) non-cerebral but severe, and 1 of 31 (3%) uncomplicated cases. Direct ophthalmoscopy missed retinopathy in one of these cases and found fewer retinal hemorrhages (mean difference = 3.09; 95% confidence interval = 1.50–4.68; P < 0.0001). Severity of retinopathy increased with severity of disease (P for trend < 0.0001), and renal failure, acidosis, and moderate/severe retinopathy were independent predictors of mortality by both ophthalmoscopic techniques. Direct ophthalmoscopy by non-ophthalmologists is an important clinical tool to aid diagnosis and prognosis in adults with severe malaria, and indirect ophthalmoscopy by non-ophthalmologists, although more sensitive, provides minimal additional prognostic information. PMID:21212217

  17. Randomised placebo-controlled trial of lisinopril in normotensive patients with insulin-dependent diabetes and normoalbuminuria or microalbuminuria. The EUCLID Study Group.

    PubMed

    1997-06-21

    Renal disease in people with insulin-dependent diabetes (IDDM) continues to pose a major health threat. Inhibitors of angiotensin-converting enzyme (ACE) slow the decline of renal function in advanced renal disease, but their effects at earlier stages are unclear, and the degree of albuminuria at which treatment should start is not known. We carried out a randomised, double-blind, placebo-controlled trial of the ACE inhibitor lisinopril in 530 men and women with IDDM aged 20-59 years with normoalbuminuria or microalbuminuria. Patients were recruited from 18 European centres, and were not on medication for hypertension. Resting blood pressure at entry was at least 75 and no more than 90 mm Hg diastolic, and no more than 155 mm Hg systolic. Urinary albumin excretion rate (AER) was centrally assessed by means of two overnight urine collections at baseline, 6, 12, 18, and 24 months. There were no difference in baseline characteristics by treatment group; mean AER was 8.0 micrograms/min in both groups; and prevalence of microalbuminuria was 13% and 17% in the placebo and lisinopril groups, respectively. On intention-to-treat analysis at 2 years, AER was 2.2 micrograms/min lower in the lisinopril than in the placebo group, a percentage difference of 18.8% (95% CI 2.0-32.7, p = 0.03), adjusted for baseline AER and centre, absolute difference 2.2 micrograms/min. In people with normoalbuminuria, the treatment difference was 1.0 microgram/min (12.7% [-2.9 to 26.0], p = 0.1). In those with microalbuminuria, however, the treatment difference was 34.2 micrograms/min (49.7% [-14.5 to 77.9], p = 0.1; for interaction, p = 0.04). For patients who completed 24 months on the trial, the final treatment difference in AER was 38.5 micrograms/min in those with microalbuminuria at baseline (p = 0.001), and 0.23 microgram/min in those with normoalbuminuria at baseline (p = 0.6). There was no treatment difference in hypoglycaemic events or in metabolic control as assessed by glycated

  18. Pharmacologic vitreolysis in diabetic retinopathy.

    PubMed

    El-Asrar, Ahmed M Abu; Al-Mezain, Hani S

    2011-03-01

    Diabetic retinopathy remains a major cause of worldwide preventable blindness. The vitreo-retinal interface plays a critical role in the pathogenesis of diabetic retinopathy. The term pharmacologic vitreolysis refers to the use of enzymes to liquefy the vitreous gel, and to induce posterior vitreous detachment (PVD). Intravitreal ovine hyaluronidase injection was effective in clearing vitreous hemorrhage. Several human case series demonstrated that intravitreal injection of autologous plasmin enzyme was a safe and effective adjunct to vitreous surgery for the treatment of diabetic macular edema and proliferative diabetic retinopathy. Recently, it was shown that intravitreal injection of plasmin enzyme without the performance of vitrectomy induced complete PVD and reduced macular thickening due to refractory diabetic macular edema.

  19. Periodontitis is associated with diabetic retinopathy in non-obese adults.

    PubMed

    Song, Su Jeong; Lee, Seong-Su; Han, Kyungdo; Park, Jun-Beom

    2017-04-01

    Patients with diabetes retinopathy appear to show increased susceptibility to periodontal disease. This study was performed to assess the relationship between periodontitis and the prevalence of diabetic retinopathy in a large probability sample of the Korean population. A subgroup analysis was performed using body mass index <25 kg/m(2) as the criterion to evaluate the effect of obesity on this relationship. This study is based on data from the Korean National Health and Nutrition Examination Survey of the Korean population, conducted between 2008 and 2010. The presence of diabetic retinopathy in relation to demographic variables and anthropometric characteristics of the participants is presented as means with their standard errors. The presence of periodontitis and presence of retinopathy categorized by body mass index (<25 and ≥25 kg/m(2)) were evaluated. Multiple logistic regression analyses were used to assess the associations between periodontitis and diabetic retinopathy after adjustment with variables, including age, sex, smoking, drinking, exercise, hypertension, metabolic syndrome, HbA1c, and duration of diabetes mellitus. There was a statistically significant increase in the prevalence of periodontitis in individuals who had proliferative diabetic retinopathy. The odds ratios [95% confidence intervals] of prevalence of diabetic retinopathy were 1.193 [0.757-1.881] for the whole population after adjustments with confounding factors. Subgroup analysis after adjustments with confounding factors showed that the odds ratios [95% confidence intervals] of prevalence were 2.206 [1.114-4.366] and 0.588 [0.326-1.061] among participants with body mass index <25 kg/m(2) and body mass index 37 ≥25 kg/m(2), respectively. The diabetic retinopathy was positively associated with the presence of periodontitis in non-obese diabetic Korean adults after adjustment with confounding variables. Our findings suggest that when a periodontist finds the presence of

  20. Significance of microalbuminuria in relation to subclinical coronary atherosclerosis in asymptomatic nonhypertensive, nondiabetic subjects.

    PubMed

    Park, Hyo Eun; Heo, Nam Ju; Kim, Minkyung; Choi, Su-Yeon

    2013-03-01

    We aimed to investigate the significance of microalbuminuria and its relationship with subclinical atherosclerosis in nonhypertensive and nondiabetic patients, by using coronary artery computed tomography (CT). A total of 1,318 nonhypertensive and nondiabetic subjects who had taken coronary artery CT and measured spot urine albumin to creatinine ratio (UACR) were evaluated. The atherosclerotic changes of coronary arteries were greater in subjects with microalbuminuria, reflected by coronary artery calcium score (CACS) and significant coronary artery stenosis (CACS ≥ 100 in 15.3% vs 7.6% and stenosis ≥ 50% in 11.5% vs 4.9% of patients with vs without microalbuminuria, P = 0.008 and P = 0.011, respectively). Among various parameters that are known as a risk factor or possible biomarkers of coronary artery disease, presence of microalbuminuria, age and Framingham risk score were significantly related to coronary artery stenosis. Among them the presence of microalbuminuria showed stronger correlation than others to the coronary artery stenosis detected by CT, even after adjusting confounding factors (OR 3.397, 95% confidence interval 1.138 to 10.140, P = 0.028). The presence of microalbuminuria by UACR was significantly associated with presence of coronary artery stenosis ≥ 50% in asymptomatic, nonhypertensive and nondiabetic general population. Our study suggests that the presence of microalbuminuria may imply subclinical coronary artery disease, even in asymptomatic population.

  1. The association between glycemic control and microalbuminuria in Type 2 diabetes.

    PubMed

    Showail, Anwar Ali; Ghoraba, Medhat

    2016-05-01

    Microalbuminuria is an independent risk factor for cardiovascular and renal out- come in a patient with Type 2 diabetes. The evidence that intensive glycemic control reduces the microvascular complications of diabetes is based almost exclusively on prevention of micro- albuminuria. To evaluate the association between microalbuminuria and glycemic control and other factors in Type 2 diabetes, we studied retrospectively 551 patients with Type 2 diabetes. The patients were divided into two groups: 175 patients with microalbuminuria in the case group and 376 with normal urine albumin-creatinine ratio in the control group. Our data indicated that there was a significant association between the uncontrolled glycemia and development of microalbuminuria and that was more obvious if HbA1c level was >11%. Our data also indicate that there was a statistical significant association between male gender, age, the systolic and diastolic blood pressure (DBP) levels, and the microalbuminuria in crude odds ratios (ORs). We conclude that there was a clear association between the glycemic control and microalbuminuria, and microalbuminuria was associated with older age, male gender, and systolic and DBP in crude ORs.

  2. Early Clinical Implications of Microalbuminuria in Patients with Acute Ischaemic Stroke

    PubMed Central

    Pais, Christopher C.

    2016-01-01

    Introduction Cardiovascular and cerebrovascular diseases are leading causes of morbidity and mortality worldwide. Stroke accounts for the second leading cause of death, about 11.13% of total deaths worldwide. Microalbuminuria is known to be associated with increased risk of mortality in ischaemic stroke patients. But there have been no studies to assess whether microalbuminuria affects the early clinical outcome of patients with acute ischaemic stroke. Aim This study aims to investigate whether microalbuminuria affects the early clinical outcome of patients with acute ischaemic stroke. Materials and Methods This is a prospective study of patients with ischaemic stroke (who presented within 24 hours of symptom onset) who were consecutively admitted in three tertiary care centres during the time period from November 2013 to June 2015. Early clinical outcomes in patients were assessed by investigating the presence of Early Neurological Deterioration (END) using the National Institute of Health Stroke Scale. Urine albumin creatinine ratio was divided into two categories – Normal (less than 30mg/g of creatinine) or Urine Microalbuminuria (30-300 mg/g of creatinine). Results Total 42 out of 70 patients (60%) were found to have microalbuminuria. In multivariate logistic regression analysis, microalbuminuria was found to be independently associated with END in patients with acute ischaemic stroke (p=0.044). Conclusion In the early periods following acute ischaemic stroke, patients with microalbuminuria have worse clinical outcome. PMID:27790489

  3. [Eclipse retinopathy: three case reports].

    PubMed

    Drake-Casanova, P; Bolívar-de-Miguel, G; Castro-Rebollo, M; Clement-Corral, M; Dapena-Sevilla, I; Pareja-Esteban, J

    2007-09-01

    We present the evolution of eclipse retinopathy in 3 patients who came to our hospital after the eclipse of October 2005 and had foveal lesions and visual field alterations. Eclipse retinopathy is a maculopathy that occurs after exposure to intense solar radiation, such as occurs during an eclipse, and is produced by a photochemical mechanism. Although the macular changes and symptoms are usually reversible, residual defects at the level of the EPR and scotoma in visual fields can occur. For these reasons the most appropriate treatment is prevention by means of public awareness campaigns.

  4. Pharmacologic therapies for diabetic retinopathy and diabetic macular edema.

    PubMed

    Rechtman, Ehud; Harris, Alon; Garzozi, Hanna J; Ciulla, Thomas A

    2007-12-01

    Diabetic retinopathy (DR) and diabetic macular edema (DME) are leading causes of blindness in the working-aged population of most developed countries. The increasing number of persons with diabetes worldwide suggests that DR/DME will continue to be major contributors to vision loss and associated functional impairment for years to come. Early detection of retinopathy in persons with diabetes is critical in preventing visual loss, but current methods of screening fail to identify a sizable number of high-risk patients. The control of diabetes-associated metabolic abnormalities (ie, hyperglycemia, hyperlipidemia, and hypertension) is also important in preserving visual function, as these conditions have been identified as risk factors for both the development and progression of DR/DME. The non-pharmacologic interventions for DR/DME, laser photocoagulation and vitrectomy, only target advanced stages of disease. Several biochemical mechanisms, including increased vascular endothelial growth factor production, protein kinase C beta activation, oxidative stress, and accumulation of intracellular sorbitol and advanced glycosylation end products, may contribute to the vascular disruptions that characterize DR/DME. The inhibition of these pathways holds the promise of the intervention for diabetic retinopathy with higher success rate and also at earlier, non-sight-threatening stages.

  5. Epigenetic modifications and diabetic retinopathy.

    PubMed

    Kowluru, Renu A; Santos, Julia M; Mishra, Manish

    2013-01-01

    Diabetic retinopathy remains one of the most debilitating chronic complications, but despite extensive research in the field, the exact mechanism(s) responsible for how retina is damaged in diabetes remains ambiguous. Many metabolic pathways have been implicated in its development, and genes associated with these pathways are altered. Diabetic environment also facilitates epigenetics modifications, which can alter the gene expression without permanent changes in DNA sequence. The role of epigenetics in diabetic retinopathy is now an emerging area, and recent work has shown that genes encoding mitochondrial superoxide dismutase (Sod2) and matrix metalloproteinase-9 (MMP-9) are epigenetically modified, activates of epigenetic modification enzymes, histone lysine demethylase 1 (LSD1), and DNA methyltransferase are increased, and the micro RNAs responsible for regulating nuclear transcriptional factor and VEGF are upregulated. With the growing evidence of epigenetic modifications in diabetic retinopathy, better understanding of these modifications has potential to identify novel targets to inhibit this devastating disease. Fortunately, the inhibitors and mimics targeted towards histone modification, DNA methylation, and miRNAs are now being tried for cancer and other chronic diseases, and better understanding of the role of epigenetics in diabetic retinopathy will open the door for their possible use in combating this blinding disease.

  6. Hypoxic viscosity and diabetic retinopathy.

    PubMed Central

    Rimmer, T; Fleming, J; Kohner, E M

    1990-01-01

    Diabetic and sickle retinopathy have features in common--for example, venous dilatation, microaneurysms, and capillary closure preceding neovascularisation. Bearing in mind that haemoglobin in poorly controlled diabetes is abnormal and that extremely low oxygen tensions (known to cause sickling) exist in the healthy cat retina, we wished to explore the possibility that diabetic blood, like that of sickle cell disease, may become more viscous when deoxygenated. To do this we measured whole blood viscosity, under oxygenated and deoxygenated conditions, of 23 normal persons, 23 diabetic patients without retinopathy, and 34 diabetic patients with retinopathy. The shear rate used was 230 s-1, which is similar to that thought to prevail in the major retinal veins. The viscosity of blood from normal persons, corrected for packed cell volume, did not change significantly on deoxygenation: mean 4.54 (SD 0.38) cps, versus, 4.57 (0.39) paired t test, p = 0.66. Similarly the blood from diabetics without retinopathy showed no change: 4.42 (0.45) versus 4.42 (0.30), p = 0.98; whereas the blood from patients with retinopathy changed from 4.82 (0.48) to 4.95 (0.63), p = 0.027. The hypoxic viscosity ratio (deoxygenated divided by oxygenated viscosity) correlated with total serum cholesterol (r = 0.44, p = 0.018) but not with HbA1, serum glucose, triglycerides, or age. A disproportionate increase in venous viscosity relative to arterial viscosity would lead to increased intraluminal and transmural pressure and therefore exacerbate leakage across capillary walls. PMID:2378855

  7. Hypoxic viscosity and diabetic retinopathy.

    PubMed

    Rimmer, T; Fleming, J; Kohner, E M

    1990-07-01

    Diabetic and sickle retinopathy have features in common--for example, venous dilatation, microaneurysms, and capillary closure preceding neovascularisation. Bearing in mind that haemoglobin in poorly controlled diabetes is abnormal and that extremely low oxygen tensions (known to cause sickling) exist in the healthy cat retina, we wished to explore the possibility that diabetic blood, like that of sickle cell disease, may become more viscous when deoxygenated. To do this we measured whole blood viscosity, under oxygenated and deoxygenated conditions, of 23 normal persons, 23 diabetic patients without retinopathy, and 34 diabetic patients with retinopathy. The shear rate used was 230 s-1, which is similar to that thought to prevail in the major retinal veins. The viscosity of blood from normal persons, corrected for packed cell volume, did not change significantly on deoxygenation: mean 4.54 (SD 0.38) cps, versus, 4.57 (0.39) paired t test, p = 0.66. Similarly the blood from diabetics without retinopathy showed no change: 4.42 (0.45) versus 4.42 (0.30), p = 0.98; whereas the blood from patients with retinopathy changed from 4.82 (0.48) to 4.95 (0.63), p = 0.027. The hypoxic viscosity ratio (deoxygenated divided by oxygenated viscosity) correlated with total serum cholesterol (r = 0.44, p = 0.018) but not with HbA1, serum glucose, triglycerides, or age. A disproportionate increase in venous viscosity relative to arterial viscosity would lead to increased intraluminal and transmural pressure and therefore exacerbate leakage across capillary walls.

  8. Subclinical Hypothyroidism Is Independently Associated with Microalbuminuria in a Cohort of Prediabetic Egyptian Adults

    PubMed Central

    Abd El-Hafez, Hala A.; El Shabrawy, Walaa Othman; Abdel Aal, Ibrahim A.

    2013-01-01

    Background Recent evidence has suggested an association between subclinical hypothyroidism (SCH) and microalbuminuria in patients with type 2 diabetes. However, whether SCH is related to microalbuminuria among subjects with prediabetes has not been studied. Thus, we evaluated the association between SCH and microalbuminuria in a cohort of prediabetic Egyptian adults. Methods A total of 147 prediabetic subjects and 150 healthy controls matched for age and sex were enrolled in this study. Anthropometric measurements, plasma glucose, lipid profile, homeostasis model assessment of insulin resistance (HOMA-IR), thyroid stimulating hormone (TSH), free thyroxine, triiodothyronine levels, and urinary albumin-creatinine ratio (UACR) were assessed. Results The prevalence of SCH and microalbuminuria in the prediabetic subjects was higher than that in the healthy controls (16.3% vs. 4%, P<0.001; and 12.9% vs. 5.3%, P=0.02, respectively). Prediabetic subjects with SCH were characterized by significantly higher HOMA-IR, TSH levels, UACR, and prevalence of microalbuminuria than those with euthyroidism. TSH level was associated with total cholesterol (P=0.05), fasting insulin (P=0.01), HOMA-IR (P=0.01), and UACR (P=0.005). UACR was associated with waist circumference (P=0.01), fasting insulin (P=0.05), and HOMA-IR (P=0.02). With multiple logistic regression analysis, SCH was associated with microalbuminuria independent of confounding variables (β=2.59; P=0.01). Conclusion Our findings suggest that prediabetic subjects with SCH demonstrate higher prevalence of microalbuminuria than their non-SCH counterparts. SCH is also independently associated with microalbuminuria in prediabetic subjects. Screening and treatment for SCH may be warranted in those patients. PMID:24404516

  9. Pericyte loss in diabetic retinopathy: mechanisms and consequences.

    PubMed

    Beltramo, Elena; Porta, Massimo

    2013-01-01

    The onset of diabetic retinopathy is characterized by morphologic alterations of the microvessels, with thickening of the basement membrane, loss of inter-endothelial tight junctions and early and selective loss of pericytes, together with increased vascular permeability, capillary occlusions, microaneurysms and, later, loss of endothelial cells (EC). A key role in the evolution of the disease is played by pericytes, specialized contractile mesenchymal cells of mesodermal origin, that, in capillaries, exert a function similar to smooth muscle cells in larger vessels, regulating vascular tone and perfusion pressure. Thickening of the basement membrane, together with systemic and local hypertension, hyperglycaemia, advanced glycation end-product formation and hypoxia, may disrupt the tight link between pericytes and EC causing pericyte apoptosis, while endothelium, deprived of proliferation control, can give rise to new vessels. Pericyte dropout has great consequences on capillary remodelling and may cause the first abnormalities of the diabetic eye which can be observed clinically. Hyperglycaemia and local hypertension are known to be a direct cause of pericyte apoptosis and dropout, and intracellular biochemical pathways of the glucose metabolites have been explored. However, the exact mechanisms are not yet fully understood and need further clarification in order to develop new effective drugs for the prevention of retinopathy.

  10. Diabetes and diabetic retinopathy in a Mexican-American population: Proyecto VER.

    PubMed

    West, S K; Klein, R; Rodriguez, J; Muñoz, B; Broman, A T; Sanchez, R; Snyder, R

    2001-07-01

    The prevalence rate of diabetes is probably higher in Hispanics than in Caucasians, although there is controversy about differences in the risk of diabetic retinopathy. The purpose of the study is to determine the prevalence rates of diabetes and diabetic retinopathy in a population-based study of Hispanics aged > or = 40 years. Proyecto VER is a random sample of Hispanic populations aged > or = 40 years in Arizona. A total of 4,774 individuals (71.6% of the eligible sample) completed the examinations. Diabetes was defined as self-report of a physician diagnosis or HbA(1c) value of > or = 7.0%. Diabetic retinopathy was assessed on stereo fundus photographs of fields 1, 2, and 4. The prevalence rate of diabetes in the Hispanic community (individuals > or = 40 years of age) was 22%. The prevalence rate of diabetic retinopathy (DR) was 48%; 32% had moderate to severe nonproliferative and proliferative retinopathy. DR increased with increasing duration of diabetes and increasing level of HbA(1c). The prevalence rate of DR-like changes in the sample of individuals without diabetic retinopathy was 15% and was not associated with hypertension, systolic blood pressure, or diastolic blood pressure. The prevalence rate of diabetes in this population of Hispanics is high, almost twice that of Caucasians. The prevalence rate of DR is high but similar to reports in a Caucasian population. The prevalence rate of 9% moderate to severe retinopathy in the newly diagnosed group suggests that efforts to improve detection and treatment of diabetes in Hispanics may be warranted.

  11. [The visual evoked potentials in diabetic retinopathy].

    PubMed

    Costache, Doina; Damian, Carmen; Iancău, Maria

    2004-01-01

    The recording of Visual Evoked Potential alterations at the patients with diabetic retinopathy. It was performed the Visual Evoked Potential recordings at 24 patients with diabetic retinopathy in different stages of evolution, with or without complications. The type of Visual Evoked Potential recording was pattern reversal with vertical bars. We followed the diagram alterations in correlation with the evolution stages of diabetic retinopathy and the visual parameter alterations. In all cases we recorded alteration of the Visual Evoked Potential. In nonproliferative diabetic retinopathy was noticed the delay of P100 wave with inconstant presence of the N75 and N135 waves. In proliferative diabetic retinopathy and its complications the alterations of the tract were important. The gradual alteration of the Visual Evoked Potential tract at the patients with diabetic retinopathy represents a prognosis of the disease.

  12. Hypertensive Target Organ Damage in Ghanaian Civil Servants with Hypertension

    PubMed Central

    Addo, Juliet; Smeeth, Liam; Leon, David A.

    2009-01-01

    Background Low levels of detection, treatment and control of hypertension have repeatedly been reported from sub Saharan Africa, potentially increasing the likelihood of target organ damage. Methods A cross-sectional study was conducted on 1015 urban civil servants aged≥25 years from seven central government ministries in Accra, Ghana. Participants diagnosed to have hypertension were examined for target organ involvement. Hypertensive target organ damage was defined as the detection of any of the following: left ventricular hypertrophy diagnosed by electrocardiogram, reduction in glomerular filtration rate, the presence of hypertensive retinopathy or a history of a stroke. Results Of the 219 hypertensive participants examined, 104 (47.5%) had evidence of target organ damage. The presence of target organ damage was associated with higher systolic and diastolic blood pressure levels. The odds of developing hypertensive target organ damage was five to six times higher in participants with blood pressure (BP)≥180/110 mmHg compared to those with BP<140/90 mmHg, and there was a trend to higher odds of target organ damage with increasing BP (p = 0.001). Women had about lower odds of developing target organ damage compared to men. Conclusions The high prevalence of target organ damage in this working population associated with increasing blood pressure, emphasises the need for hypertension control programs aimed at improving the detection of hypertension, and importantly addressing the issues inhibiting the effective treatment and control of people with hypertension in the population. PMID:19701488

  13. The comparison of QT dispersion and 24 hour ambulatory blood pressure monitoring amongst diabetic patients with and without microalbuminuria.

    PubMed

    Yeo, C K; Hapizah, M N; Khalid, B A K; Wan Nazainimoon, W M; Khalid, Y

    2004-06-01

    Diabetes mellitus is an important coronary artery disease risk factor. The presence of microalbuminuria, which indicates renal involvement in diabetic patients, is associated with an increased cardiovascular risk. There are suggestions that diabetic patients with microalbuminuria have more adverse risk profile such as higher ambulatory blood pressure and total cholesterol levels to account for the increased cardiovascular morbidity and mortality. QT dispersion is increasingly being recognized as a prognostic factor for coronary artery disease and sudden death. Some studies have suggested that QT dispersion is an important predictor of mortality in Type II diabetic patients. Our cross sectional study was to compare the QT dispersion and 24 hour ambulatory blood pressure monitoring between diabetic patients with microalbuminuria and those without microalbuminuria. Diabetic patients with overt coronary artery disease were excluded from the study. A total of 108 patients were recruited of which 57 patients had microalbuminuria and 51 were without microalbuminuria. The mean value of QT dispersion was significantly higher in patients with microalbuminuria than in patients without microalbuminuria (58.9 +/- 27.9 ms vs. 47.1 +/- 25.0 ms, p < 0.05). The mean 24 hour systolic and diastolic blood pressures were significantly higher in patients with microalbuminuria than in patients without microalbuminuria (129.5 +/- 12.3 mm Hg vs 122.3 +/- 10.2 mm Hg, p < 0.05 and 78.4 +/- 6.9 mm Hg vs 75.3 +/- 6.8 mm Hg, p < 0.05, respectively). Our study suggests that QT dispersion prolongation, related perhaps to some autonomic dysfunction, is an early manifestation of cardiovascular aberration in diabetic patients with microalbuminuria. The higher blood pressure levels recorded during a 24-hour period min diabetics with microalbuminuria could also possibly account for the worse cardiovascular outcome in this group of patients.

  14. Retinopathy screening in children and adolescents with diabetes.

    PubMed

    Raman, V; Campbell, F; Holland, P; Chapman, T; Dabbs, T; Bodansky, H J; O'Neill, D P

    2002-04-01

    Diabetic retinopathy is a complication of diabetes that affects the blood vessels of the retina. The majority of patients with diabetic retinopathy exhibit background retinopathy. In approximately 10% of patients, background retinopathy will progress to sight-threatening retinopathy. The aims of our study were to measure the prevalence of retinopathy among our population and to assess the optimal time of screening children and adolescents with type 1 diabetes.

  15. Retinopathy and chronic kidney disease in the Chronic Renal Insufficiency Cohort (CRIC) study.

    PubMed

    Grunwald, Juan E; Alexander, Judith; Ying, Gui-Shuang; Maguire, Maureen; Daniel, Ebenezer; Whittock-Martin, Revell; Parker, Candace; McWilliams, Kathleen; Lo, Joan C; Go, Alan; Townsend, Raymond; Gadegbeku, Crystal A; Lash, James P; Fink, Jeffrey C; Rahman, Mahboob; Feldman, Harold; Kusek, John W; Xie, Dawei; Jaar, Bernard G

    2012-09-01

    To investigate the association between retinopathy and chronic kidney disease. In this observational, cross-sectional study, 2605 patients of the Chronic Renal Insufficiency Cohort (CRIC) study, a multicenter study of chronic kidney disease, were offered participation. Nonmydriatic fundus photographs of the disc and macula in both eyes were obtained in 1936 of these subjects. The photographs were reviewed in a masked fashion at a central photograph reading center using standard protocols. Presence and severity of retinopathy (diabetic, hypertensive, or other) and vessel diameter caliber were assessed by trained graders and a retinal specialist using protocols developed for large epidemiologic studies. Kidney function measurements and information on traditional and nontraditional risk factors for decreased kidney function were obtained from the CRIC study. Greater severity of retinopathy was associated with lower estimated glomerular filtration rate after adjustment for traditional and nontraditional risk factors. The presence of vascular abnormalities usually associated with hypertension was also associated with lower estimated glomerular filtration rate. We found no strong direct relationship between estimated glomerular filtration rate and average arteriolar or venular calibers. Our findings show a strong association between severity of retinopathy and its features and level of kidney function after adjustment for traditional and nontraditional risk factors for chronic kidney disease, suggesting that retinovascular pathology reflects renal disease.

  16. Prevalence and incidence of retinopathy in elderly diabetic patients receiving early diagnosis and treatment

    PubMed Central

    LI, XIN; WANG, ZHAOYAN

    2013-01-01

    Diabetic retinopathy (DR) is one of the most common and specific complications of diabetes. Thus, intervention is required to lower the incidence and prevalence of sight-threatening retinopathy. The aim of this study was to investigate the prevalence and incidence of diabetic retinopathy in elderly diabetic patients receiving early diagnosis and proper treatment and to explore risk factors for DR. From May 2005 to May 2011, fundus examination was performed for elderly diabetic patients during routine medical examinations. The presence of a microaneurysm or more severe presentations was used to diagnose DR, which was followed by fundus fluorescein angiography. Logistic regression analysis was employed to analyze the risk factors for DR development within 5 years. A total of 2,194 diabetic patients were recruited and followed-up for a mean of 5.8 years. The prevalence of DR was 15.38–16.20% and the incidence of DR was 8.38/1,000 person-years. Logistic multiple stepwise regression revealed that fasting plasma glucose (FPG), mean arterial pressure (MAP), duration of diabetes, body mass index (BMI) and microalbuminuria (MAU) were significantly associated with the occurrence of DR (all P<0.05). In the present study, the prevalence and incidence of DM were higher compared with those reported in the general population; however, the prevalence and incidence of DR were lower compared with those reported in similar studies. This suggests that favorable control of blood glucose, blood pressure and blood lipids effectively prevents the occurrence of DR in diabetic patients. PMID:23737887

  17. Nanotechnology and Nanotoxicology in Retinopathy

    PubMed Central

    Jo, Dong Hyun; Lee, Tae Geol; Kim, Jeong Hun

    2011-01-01

    Nanoparticles are nanometer-scaled particles, and can be utilized in the form of nanocapsules, nanoconjugates, or nanoparticles themselves for the treatment of retinopathy, including angiogensis-related blindness, retinal degeneration, and uveitis. They are thought to improve the bioavailability in the retina and the permeability of therapeutic molecules across the barriers of the eye, such as the cornea, conjunctiva, and especially, blood-retinal barriers (BRBs). However, consisting of multiple neuronal cells, the retina can be the target of neuronal toxicity of nanoparticles, in common with the central and peripheral nervous system. Furthermore, the ability of nanoparticles to pass through the BRBs might increase the possibility of toxicity, simultaneously promoting distribution in the retinal layers. In this regard, we discussed nanotechnology and nanotoxicology in the treatment of retinopathy. PMID:22174664

  18. Educational paper: Retinopathy of prematurity.

    PubMed

    Casteels, Ingele; Cassiman, Catherine; Van Calster, Joachim; Allegaert, Karel

    2012-06-01

    Retinopathy of prematurity (ROP) is a proliferative retinal vascular disease affecting the premature infant with an incompletely vascularized retina. The spectrum of ophthalmological findings in ROP exists from minimal sequelae, which do not affect vision, to bilateral retinal detachment and total blindness. With the increased survival of very small infants, retinopathy of prematurity has become one of the leading causes of childhood blindness. Over the past two decades, major advances have been made in understanding the pathogenesis of ROP, to a large extent as a result of changes in clinical risk factors (oxygen and non-oxygen related) and characteristics observed in ROP cases. This article provides a literature review on the evolution in clinical characteristics, classification and treatment modalities and indications of ROP. Special attention is hereby paid to the neonatal factors influencing the development of ROP and to the necessity for everyone caring for premature babies to have a well-defined screening and treatment protocol for ROP. Such screening protocol needs to be based on a unit-specific ROP risk profile and, consequently, may vary between different European regions. Retinopathy of prematurity is an important cause of ocular morbidity and blindness in children. With better understanding of the pathogenesis, screening and treatment guidelines have changed over time and are unit specific.

  19. The Diabetic Retinopathy Screening Workflow

    PubMed Central

    Bolster, Nigel M.; Giardini, Mario E.; Bastawrous, Andrew

    2015-01-01

    Complications of diabetes mellitus, namely diabetic retinopathy and diabetic maculopathy, are the leading cause of blindness in working aged people. Sufferers can avoid blindness if identified early via retinal imaging. Systematic screening of the diabetic population has been shown to greatly reduce the prevalence and incidence of blindness within the population. Many national screening programs have digital fundus photography as their basis. In the past 5 years several techniques and adapters have been developed that allow digital fundus photography to be performed using smartphones. We review recent progress in smartphone-based fundus imaging and discuss its potential for integration into national systematic diabetic retinopathy screening programs. Some systems have produced promising initial results with respect to their agreement with reference standards. However further multisite trialling of such systems’ use within implementable screening workflows is required if an evidence base strong enough to affect policy change is to be established. If this were to occur national diabetic retinopathy screening would, for the first time, become possible in low- and middle-income settings where cost and availability of trained eye care personnel are currently key barriers to implementation. As diabetes prevalence and incidence is increasing sharply in these settings, the impact on global blindness could be profound. PMID:26596630

  20. Solar Retinopathy: A Multimodal Analysis

    PubMed Central

    Bruè, Claudia; Mariotti, Cesare; De Franco, Edoardo; Fisher, Yale; Giovannini, Alfonso

    2013-01-01

    Purpose. Solar retinopathy is a rare clinical disturbance, for which spectral-domain optical coherence tomography (SD-OCT) findings are not always consistent. We report on two cases of solar retinopathy and discuss its differential diagnosis. Methods. This is an observational case study. Results. A 12-year-old female was referred to ophthalmology for bilateral scotoma. Visual acuity was 20/50 in both eyes. Fundus examination was unremarkable, except for slight yellowish material in the central macula, bilaterally. SD-OCT revealed juxtafoveal microcystic cavities in the outer retina, interruption of the external limiting membrane and the inner and outer segment junctions, with disorganized material in the vitelliform space. Fundus autofluorescence showed hypoautofluorescence surrounded by a relatively hyperautofluorescent ring, bilaterally. Similar clinical and morphological findings were detected in a 27-year-old male. Conclusions. Solar retinopathy has a subtle presentation and patients often deny sun-gazing. SD-OCT and fundus autofluorescence are noninvasive and useful tools for its diagnosis. PMID:23476848

  1. Solar retinopathy: a multimodal analysis.

    PubMed

    Bruè, Claudia; Mariotti, Cesare; De Franco, Edoardo; Fisher, Yale; Guidotti, Jacopo Maria; Giovannini, Alfonso

    2013-01-01

    Purpose. Solar retinopathy is a rare clinical disturbance, for which spectral-domain optical coherence tomography (SD-OCT) findings are not always consistent. We report on two cases of solar retinopathy and discuss its differential diagnosis. Methods. This is an observational case study. Results. A 12-year-old female was referred to ophthalmology for bilateral scotoma. Visual acuity was 20/50 in both eyes. Fundus examination was unremarkable, except for slight yellowish material in the central macula, bilaterally. SD-OCT revealed juxtafoveal microcystic cavities in the outer retina, interruption of the external limiting membrane and the inner and outer segment junctions, with disorganized material in the vitelliform space. Fundus autofluorescence showed hypoautofluorescence surrounded by a relatively hyperautofluorescent ring, bilaterally. Similar clinical and morphological findings were detected in a 27-year-old male. Conclusions. Solar retinopathy has a subtle presentation and patients often deny sun-gazing. SD-OCT and fundus autofluorescence are noninvasive and useful tools for its diagnosis.

  2. Prevalence of microalbuminuria with relation to glycemic control in type-2 diabetic patients in Karachi.

    PubMed

    Sheikh, Shehnaz A; Baig, Jawed Altaf; Iqbal, Tehseen; Kazmi, Tahseen; Baig, Muhammad; Husain, Syed Shajee

    2009-01-01

    Diabetes is one of the most common endocrine disorders characterized by hyperglycaemia. Diabetic nephropathy is a consequence of long standing diabetes. The prevalence of microalbuminuria predicts progression to diabetic nephropathy. The present study was conducted to determine the prevalence of microalbuminuria in relation to duration of diabetes, BMI, Serum Creatinine and HbA1c in an ethnic group of Type 2 diabetes mellitus residing in Karachi. This cross-sectional descriptive study was carried out in a community diabetic centre, located at Garden East Karachi from July to December 2007. One hundred known Type 2 diabetic patients with age 30-70 years were included in the study. Informed consent and a structured questionnaire of each patient were recorded. Fasting venous blood and morning urine sample was collected for analysis of creatinine, HbA1c and microalbuminuria respectively. Statistical analysis was done using SPSS version 13.0. Pearson correlation was applied to observe association of microalbuminuria with different parameters. All p-values < 0.05 were considered as statistically significant. Microalbuminuria had a highly significant correlation with duration of diabetes, serum creatinine (p < 0.001), HbA1c (p < 0.05) and BMI (p < 0.024). A strong correlation exists between age and serum creatinine (r = 0.73). The present study found an early onset of microalbuminuria in the selected community which could be due to poor glycaemic control (high HbA1c > 7%) or heredity factors. Screening for microalbuminuria and HbAlc test should be done in both newly and already diagnosed Type 2 diabetic patients as an early marker of renal dysfunction and glycaemic control.

  3. Relationships Between Metabolic Syndrome, Microalbuminuria, and C-Reactive Protein in Turkish Kidney Transplant Recipients.

    PubMed

    Sipahioglu, M H; Unal, A; Yazgac, H; Tunca, O; Arikan, T; Kocyigit, I; Tokgoz, B; Oymak, O

    2015-06-01

    The aims of this study were to report the prevalence of metabolic syndrome (MS) in a cohort of Turkish kidney transplant recipients and to define the relationships between MS, microalbuminuria and C-reactive protein (CRP), which are cardiovascular risk factors, in kidney transplant setting. This cross sectional study included 170 adult renal transplantation recipients with a mean follow-up of 53.1 ± 49.9 months. The diagnosis of MS was made according to the National Cholesterol Education Program-Adult Treatment Panel III (NCEP-ATP III) criteria. Microalbuminuria was defined as a urinary albumin/creatinine ratio of 30-300 mg/g. CRP levels ≥6.0 were classified as high CRP. Mean age was 39.3 ± 11 years. The prevalence of MS was 45.8% (n = 78). The prevalence of microalbuminuria was not different in patients with MS compared to those without MS (39.7% vs 37%, P = .428). In multivariate logistic regression analyses, systolic blood pressure (SBP) (odds ratio 1.68; 95% confidence interval [CI] 1.12-2.52; P = .011) and high fasting glucose (odds ratio 2.82; 95% confidence interval [CI] 1.16-6.86; P = .022) were significantly associated with microalbuminuria. When patients with MS and high CRP were compared with patients with normal CRP and without MS, microalbuminuria did not differ between the groups (P = .213). The prevalence of MS in our kidney recipient cohort was found to be increased compared to general population. MS was not related to increased prevalence of microalbuminuria, even when combined with high CRP. Microalbuminuria was associated with elevated SBP and hyperglycemic status. Copyright © 2015 Elsevier Inc. All rights reserved.

  4. All Components of Metabolic Syndrome Are Associated with Microalbuminuria in a Chinese Population.

    PubMed

    Lee, Yi-Yen; Yang, Chih-Kai; Weng, Yi-Ming; Chuang, Chung-Hsun; Yu, Wei; Chen, Jih-Chang; Li, Wen-Cheng

    2016-01-01

    Albuminuria is a well-known predictor of poor renal and cardiovascular outcomes and associated with increased risk of all-cause mortality. The study aimed to evaluate the associations between metabolic characteristics and the presence of albuminuria. This cross-sectional study included 18,384 adult Chinese who participated in health examinations during 2013-2014. Differences in clinical characteristics were compared for microalbuminuria (MAU) and albuminuria, and between genders. Potential risk factors associated with the risk of developing MAU and albuminuria were analyzed using univariate logistic regression. Multiple logistic regression was applied to further identify the independent associations between different levels of risk factors and the presence of MAU and albuminuria. The area under the ROC curve (AUC) was used to determine the discriminatory ability of metabolic risk factors in detecting albuminuria. There were significant gender differences in clinical characteristics according to albuminuria status. Risk for the presence of albuminuria was significantly associated with age, male gender, waist circumference (WC), waist-to-height ratio (WHtR), hypertension, fasting plasma glucose (FPG), and triglycerides to high-density lipoprotein cholesterol ratio (TG/HDL-C) in univariate logistic regression. Multiple logistic regression analysis indicated that the factors significantly associated with the presence of MAU were WC > 90cm, WHtR at 0.6-0.7, hypertension, FPG > 6.1 mmole/L, and TG/HDL-C ratio > 1.6. The optimal cutoffs for risk factors of metabolic syndrome (MetS) to predict albuminuria in males and females were: WC, 90.8 vs. 80.0 cm; WHtR, 0.53 vs. 0.52; MAP, 97.9 vs. 91.9 mmHg; FPG, 5.40 vs. 5.28 mmole/L; and TG/HDL-C, 1.13 vs. 1.08. MetS and all its components were associated with the presence of MAU in a health check-up population in China. Gender specific and optimal cutoffs for MetS components associated with the presence of MAU were determined.

  5. Association Between Retinopathy and Cardiovascular Disease in Patients with Chronic Kidney Disease (From the Chronic Renal Insufficiency Cohort [CRIC] Study)

    PubMed Central

    Grunwald, Juan E.; Ying, Gui-Shuang; Maguire, Maureen; Pistilli, Maxwell; Daniel, Ebenezer; Alexander, Judith; Whittock-Martin, Revell; Parker, Candace; Mohler, Emile; Chia-Mei Lo, Joan; Townsend, Raymond; Gadegbeku, Crystal Ann; Lash, James Phillip; Fink, Jeffrey Craig; Rahman, Mahboob; Feldman, Harold; Kusek, John Walter; Xie, Dawei; Coleman, Martha; Keane, Martin Gerard

    2012-01-01

    Patients with chronic kidney disease (CKD) experience co-morbid illneses including cardiovascular disease (CVD) and retinopathy. The purpose of this study was to assess the association between retinopathy and self reported CVD in a subgroup of the participants of the Chronic Renal Insufficiency Cohort (CRIC) study. In this observational, ancillary investigation, 2605 CRIC participants were invited to participate in this study, and non-mydriatic fundus photographs in both eyes were obtained in 1936 subjects. Photographs were reviewed in a masked fashion at a central photograph reading center. Presence and severity of retinopathy (diabetic, hypertensive or other) and vessel diameter caliber were assessed using standard protocols by trained graders masked to information about study participants. History of self-reported cardiovascular disease was obtained using a medical history questionnaire. Kidney function measurements, traditional and non-traditional risk factors for CVD were obtained from the CRIC study. Greater severity of retinopathy was associated with higher prevalence of any cardiovascular disease and this association persisted after adjustment for traditional risk factors for CVD. Presence of vascular abnormalities usually associated with hypertension was also associated with increased prevalence of CVD. We found a direct relationship between CVD prevalence and mean venular caliber. In conclusion, presence of retinopathy was associated with CVD, suggesting that retinovascular pathology may be indicative of macrovascular disease even after adjustment for renal dysfunction and traditional CVD risk factors. This would make assessment of retinal morphology a valuable tool in chronic kidney disease studies of CVD outcomes. PMID:22516527

  6. Role of macular xanthophylls in prevention of common neovascular retinopathies: retinopathy of prematurity and diabetic retinopathy.

    PubMed

    Gong, Xiaoming; Rubin, Lewis P

    2015-04-15

    Retinopathy of prematurity (ROP) and diabetic retinopathy (DR) are important causes of blindness among children and working-age adults, respectively. The development of both diseases involves retinal microvascular degeneration, vessel loss and consequent hypoxic and inflammatory pathologic retinal neovascularization. Mechanistic studies have shown that oxidative stress and subsequent derangement of cell signaling are important factors in disease progression. In eye and vision research, role of the dietary xanthophyll carotenoids, lutein and zeaxanthin, has been more extensively studied in adult onset macular degeneration than these other retinopathies. These carotenoids also may decrease severity of ROP in preterm infants and of DR in working-age adults. A randomized controlled clinical trial of carotenoid supplementation in preterm infants indicated that lutein has functional effects in the neonatal eye and is anti-inflammatory. Three multicenter clinical trials all showed a trend of decreased ROP severity in the lutein supplemented group. Prospective studies on patients with non-proliferative DR indicate serum levels of lutein and zeaxanthin are significantly lower in these patients compared to normal subjects. The present review describes recent advances in lutein and zeaxanthin modulation of oxidative stress and inflammation related to ROP and DR and discusses potential roles of lutein/zeaxanthin in preventing or lessening the risks of disease initiation or progression.

  7. Corneal autofluorescence in presence of diabetic retinopathy

    NASA Astrophysics Data System (ADS)

    Rovati, Luigi; Docchio, Franco; Azzolini, Claudio; Van Best, Jaap A.

    1998-06-01

    Recently corneal autofluorescence has been proposed as an ocular diagnostic tool for diabetic retinopathy. The method is based on the sensible increase of the natural fluorescence of corneal tissue within specific wavelength in presence of early stage of diabetic retinopathy. The main advantages of this method are that the corneal autofluorescence has been demonstrated to be not age-related and that the cornea is readily accessible to be investigated. In this study 47 insulin-dependent diabetes mellitus and 51 non-insulin- dependent diabetes mellitus patients aged 20 - 90 years have been considered. Patients were selected from the Eye Clinic of S. Raffaele Hospital. The modified Airlie House classification was used to grade the diabetic retinopathy. Corneal autofluorescence has been measured by using both a specifically designed instrument and the Fluorotron Master. Corneal autofluorescence mean value for each diabetic retinopathy measured by using both the instruments correlated with the retinopathy grade.

  8. Chlorpropamide alcohol flushing and diabetic retinopathy.

    PubMed

    Leslie, R D; Barnett, A H; Pyke, D A

    1979-05-12

    "Mason-type" diabetics (mild diabetes which is dominantly inherited) are relatively free of retinopathy. Alcohol almost invariably causes facial flushing in these patients when they are given chlorpropamide (chlorpropamide alcohol flush, C.P.A.F.). 291 non-insulin-dependent diabetics were examined to see whether there was a difference in frequency of retinopathy between C.P.A.F. positive and negative cases who were of comparable age and duration of diabetes. Retinopathy was commoner and often severe in CPAF negative patients. Blindness from retinopathy was almost confined to C.P.A.F.-negative cases. Lens opacities, on the other hand, were equally common in both groups. Since C.P.A.F. is an inherited trait, retinopathy in non-insulin-dependent diabetics is to a considerable extent, although not entirely, determined by genetic factors.

  9. Phosphate, fibroblast growth factor 23 and retinopathy in chronic kidney disease: the Chronic Renal Insufficiency Cohort Study

    PubMed Central

    Mehta, Rupal; Ying, Gui Shuang; Houston, Samuel; Isakova, Tamara; Nessel, Lisa; Ojo, Akinlolu; Go, Alan; Lash, Jim; Kusek, John; Grunwald, Juan; Wolf, Myles

    2015-01-01

    Background Elevated circulating concentrations of phosphate and fibroblast growth factor 23 (FGF23) contribute to the pathogenesis of cardiovascular disease in chronic kidney disease (CKD). Retinopathy is a common manifestation of microvascular disease in CKD, but its associations with phosphate and FGF23 have not been studied. We tested the hypothesis that higher serum phosphate is associated with more severe retinopathy in individuals with CKD, independent of FGF23 and known risk factors for retinopathy. Methods We tested the associations of serum phosphate and plasma FGF23 with retinopathy in a cross-sectional analysis of 1800 participants in the Chronic Renal Insufficiency Cohort Study who underwent fundus photography. Retinopathy severity was graded according to the Early Treatment of Diabetic Retinopathy Severity score, and retinal venous and arterial diameters were measured. Results Mean estimated glomerular filtration rate (eGFR) was 46.5 ± 15.4 mL/min/1.73 m2, mean serum phosphate was 3.7 ± 0.6 mg/dl and median plasma C-terminal FGF23 was 133 RU/mL (interquartile range 87.2, 217.8 RU/mL). In multivariable ordinal logistic regression models, higher serum phosphate was associated with greater retinopathy severity independent of hypertension, diabetes, CKD severity and FGF23 [adjusted odds ratio of being in one higher category of retinopathy severity: 1.19 per 1 standard deviation increase; 95% confidence interval (CI) 1.05, 1.36; P = 0.007]. Presence of diabetes or hypertension did not modify the results. Higher serum phosphate was also independently associated with greater retinal venous diameter (multivariable-adjusted 1.70 µm increase per 1 standard deviation increase in phosphate; 95% CI 0.46, 2.93; P = 0.007). FGF23 levels were not independently associated with retinopathy severity or retinal venous diameter, and neither FGF23 nor phosphate was associated with retinal arterial diameter. Conclusions Among individuals with moderate-to-severe CKD

  10. New-onset microalbuminuria following allogeneic myeloablative SCT is a sign of near-term decrease in renal function.

    PubMed

    Morito, T; Ando, M; Kobayashi, T; Kakihana, K; Ohashi, K; Akiyama, H; Tsuchiya, K; Nitta, K; Sakamaki, H

    2013-07-01

    The emergence of microalbuminuria following conditioning chemotherapy may predict the development of renal dysfunction. To confirm this, a 1-year retrospective cohort study was conducted in 31 myeloablative allogeneic SCT patients who received five consecutive measurements of albuminuria before conditioning therapy and on days 0, 7, 14 and 28 following SCT. The cohort had neither microalbuminuria nor renal dysfunction at baseline. Microalbuminuria was defined as an albumin-creatinine (Cr) ratio over 30 mg/g, and renal dysfunction was as an estimated glomerular filtration rate <60 mL/min per 1.73 m(2). Cumulative incidence of renal dysfunction over time was analyzed by the Kaplan-Meier method. Multivariate Cox proportional hazards analysis was used to examine an association of de novo microalbuminuria with the incidence of renal dysfunction. In all, 16 patients (52%) developed microalbuminuria that was positive at least two times among the four measurements after SCT. The actuarial occurrence of chronic kidney disease was significantly higher in patients who developed microalbuminuria than in those who did not. Incidence of microalbuminuria had a significant risk of subsequent renal dysfunction (hazard ratio (95% confidence interval), 7.3 (1.2-140)). In conclusion, de novo microalbuminuria following conditioning therapy is a warning of near-term loss of renal function.

  11. Micronutrients and diabetic retinopathy a systematic review.

    PubMed

    Lee, Chee-Tin Christine; Gayton, Emma L; Beulens, Joline W J; Flanagan, Declan W; Adler, Amanda I

    2010-01-01

    We have evaluated the evidence for the association between intake and blood levels of micronutrients and diabetic retinopathy. Treatment for diabetic retinopathy requires significant clinical input and specialist ophthalmologic care. Micronutrients, including vitamin C, vitamin E, and magnesium, may interfere with pathologic mechanisms of diabetic retinopathy and potentially alter its risk. We conducted a search of epidemiologic literature in PubMed and Embase from 1988 to May 2008, using keywords for exposures, including magnesium, ascorbic acid, alpha-tocopherol and antioxidants, and outcomes, including diabetic retinopathy. Two authors independently extracted data and assessed the quality of the studies using the Newcastle-Ottawa Scale. The overall quality of evidence was graded as I (highest), II, or III (lowest). Of the 766 studies identified, we reviewed 15 studies, comprising 4094 individuals. For vitamin C, hospital-based studies reported an inverse association between plasma levels with retinopathy, whereas population-based studies showed no association between dietary intake and retinopathy. For vitamin E, there was no association with dietary intake or plasma levels and retinopathy. For magnesium, a single prospective analysis showed an association between low levels in plasma and progression of retinopathy, but cross-sectional studies reported inconsistent results. In the assessment of quality, population-based studies had higher ratings than hospital-based studies. The evidence suggests that dietary intake or plasma levels of vitamins C and E and magnesium do not seem to be associated with diabetic retinopathy. Because of differences in study designs and measurement of micronutrients, incomplete ascertainment of retinopathy, and residual confounding, these findings require confirmation. The authors have no proprietary or commercial interest in any of the materials discussed in this article. Copyright 2010 American Academy of Ophthalmology. Published by

  12. Effect of candesartan on progression and regression of retinopathy in type 2 diabetes (DIRECT-Protect 2): a randomised placebo-controlled trial.

    PubMed

    Sjølie, Anne Katrin; Klein, Ronald; Porta, Massimo; Orchard, Trevor; Fuller, John; Parving, Hans Henrik; Bilous, Rudy; Chaturvedi, Nish

    2008-10-18

    Diabetic retinopathy remains a leading cause of visual loss in people of working age. We examined whether candesartan treatment could slow the progression and, secondly, induce regression of retinopathy in people with type 2 diabetes. We did a randomised, double-blind, parallel-group, placebo-controlled trial in 309 centres worldwide. We recruited normoalbuminuric, normotensive, or treated hypertensive people with type 2 diabetes with mild to moderately severe retinopathy and assigned them to candesartan 16 mg once a day or placebo. After a month, the dose was doubled to 32 mg once per day. Investigators and patients were unaware of the treatment allocation status. Progression of retinopathy was the primary endpoint, and regression was a secondary endpoint. Analysis was by intention to treat. The trial is registered with ClinicalTrials.gov, number NCT00252694. 1905 participants (aged 37-75 years) were randomised to candesartan (n=951) or placebo (n=954). 161 (17%) patients in the candesartan group and 182 (19%) in the placebo group had progression of retinopathy by three steps or more on the Early Treatment Diabetic Retinopathy Study scale. The risk of progression of retinopathy was non-significantly reduced by 13% in patients on candesartan compared with those on placebo (hazard ratio [HR] 0.87, 95% CI 0.70-1.08, p=0.20). Regression on active treatment was increased by 34% (1.34, 1.08-1.68, p=0.009). HRs were not attenuated by adjustment for baseline risk factors or changes in blood pressure during the trial. An overall change towards less severe retinopathy by the end of the trial was observed in the candesartan group (odds 1.17, 95% CI 1.05-1.30, p=0.003). Adverse events did not differ between the treatment groups. Treatment with candesartan in type 2 diabetic patients with mild to moderate retinopathy might induce improvement of retinopathy.

  13. Outcome of retinopathy of prematurity.

    PubMed

    Holmström, Gerd; Larsson, Eva

    2013-06-01

    In prematurely born children, various visual and ophthalmologic sequelae occur because of both retinopathy of prematurity (ROP) and preterm birth per se. Several long-term follow-up studies have described the outcome of ROP. Visual impairment and blindness are well-known consequences, but the prevalence varies globally because of differing neonatal and ophthalmologic care. Improving treatment options and criteria for the treatment of ROP are continuously changing the ophthalmologic outcome. The anatomic outcome has improved with treatment, but good anatomic outcome in treated severe ROP does not always reflect the functional outcome. There is no consensus regarding long-term follow-up of prematurely born children.

  14. Mitochondrial Haplogroups Are Associated With Severity of Diabetic Retinopathy

    PubMed Central

    Estopinal, Christopher B.; Chocron, Isaac M.; Parks, Megan B.; Wade, Emily A.; Roberson, Rachel M.; Burgess, L. Goodwin; Brantley, Milam A.; Samuels, David C.

    2014-01-01

    Purpose. To determine if specific mitochondrial haplogroups associate with nonproliferative diabetic retinopathy (NPDR) and proliferative diabetic retinopathy (PDR). Methods. Deidentified medical records for Caucasian patients with diabetic retinopathy (DR; 153 NPDR and 138 PDR) were obtained from BioVU, Vanderbilt University's electronic, deidentified DNA databank. An independent cohort of Caucasian patients with DR (44 NPDR and 57 PDR) from the Vanderbilt Eye Institute (VEI) was used for validation. We tested for an association between mitochondrial haplogroups and PDR among patients with DR. Results. In the BioVU cohort, PDR frequency among Caucasian DR patients differed significantly by mitochondrial haplogroup (P = 0.027). Replication in the VEI cohort confirmed this association (P = 0.0064). In the combined cohort, patients from the common haplogroup H were more likely to have PDR (odds ratio [OR] = 2.0 [95% confidence interval (CI) = 1.3–3.0], P = 0.0012), while patients from haplogroup Uk were less likely to have PDR (OR = 0.5 [95% CI = 0.3–0.8], P = 0.0049). In logistic regression analyses, the addition of diabetes duration, hemoglobin A1c (HgbA1c) levels, and hypertension had no effect on the associations of haplogroups H and Uk with PDR. Conclusions. In this study, DR patients from mitochondrial haplogroup H were more likely to have PDR, while DR patients from haplogroup Uk were less likely to have PDR. The association was independent of the major clinical variables affecting PDR. The mitochondrial haplogroups were as strong a risk factor for PDR as were elevated HgbA1c levels. PMID:25118268

  15. Hypertension and hypertensive encephalopathy.

    PubMed

    Price, Raymond S; Kasner, Scott E

    2014-01-01

    The definition of hypertension has continuously evolved over the last 50 years. Hypertension is currently defined as a blood pressure greater than 140/90mmHg. One in every four people in the US has been diagnosed with hypertension. The prevalence of hypertension increases further with age, affecting 75% of people over the age of 70. Hypertension is by far the most common risk factor identified in stroke patients. Hypertension causes pathologic changes in the walls of small (diameter<300 microns) arteries and arterioles usually at short branches of major arteries, which may result in either ischemic stroke or intracerebral hemorrhage. Reduction of blood pressure with diuretics, β-blockers, calcium channel blockers, and angiotensin-converting enzyme (ACE) inhibitors have all been shown to markedly reduce the incidence of stroke. Hypertensive emergency is defined as a blood pressure greater than 180/120mmHg with end organ dysfunction, such as chest pain, shortness of breath, encephalopathy, or focal neurologic deficits. Hypertensive encephalopathy is believed to be caused by acute failure of cerebrovascular autoregulation. Hypertensive emergency is treated with intravenous antihypertensive agents to reduce blood pressure by 25% within the first hour. Selective inhibition of cerebrovascular blood vessel permeability for the treatment of hypertensive emergency is beginning early clinical trials. © 2014 Elsevier B.V. All rights reserved.

  16. Prognostic Impact of Subclinical Microalbuminuria in Patients With Chronic Heart Failure.

    PubMed

    Miura, Masanobu; Sakata, Yasuhiko; Miyata, Satoshi; Nochioka, Kotaro; Takada, Tsuyoshi; Tadaki, Soichiro; Ushigome, Ryoichi; Yamauchi, Takeshi; Takahashi, Jun; Shimokawa, Hiroaki

    2014-10-30

    Background:Microalbuminuria, traditionally defined as urinary albumin/creatinine ratio (UACR) ≥30 mg/g, is a risk factor for mortality even in patients with preserved glomerular filtration rate (GFR). The prognostic impact of subclinical microalbuminuria, however, remains unknown in patients with chronic heart failure (CHF).Methods and Results:In the Chronic Heart Failure Analysis and Registry in the Tohoku District 2 Study, we enrolled 2,039 consecutive symptomatic CHF patients (median age, 67.4 years; 68.9% male) after excluding those on hemodialysis. On classification and regression tree analysis, UACR=10.2 mg/g and 27.4 mg/g were identified as the first and second discriminating points to stratify the risk for composite of death, acute myocardial infarction, HF admission and stroke, therefore subclinical microalbuminuria was defined as UACR ≥10.2 and <27.4 mg/g. There were 506 composite endpoints (24.8%) during the median follow-up of 2.69 years. On Kaplan-Meier analysis and multivariate Cox modeling, subclinical microalbuminuria was significantly associated with increased composite endpoints with hazard ratios of 1.90 (P<0.001) and 2.29 (P<0.001) in patients with preserved (>60 ml·min(-1)·1.73 m(-2), n=1,129) or mildly reduced eGFR (30-59.9 ml·min(-1)·1.73 m(-2), n=789), respectively. In patients with severely reduced GFR (eGFR <30 ml·min(-1)·1.73 m(-2), n=121), >80% had microalbuminuria or macroalbuminuria, and only 9.1% were free from any composite endpoints.Conclusions:Subclinical microalbuminuria was associated with increased risk of cardiovascular events in CHF patients with mildly reduced or preserved renal function.

  17. [Microalbuminuria and ultrasound characteristics of kidneys in children and adolescents with diabetes mellitus type 1].

    PubMed

    Hasanović, Evlijana; Tulumović, Denijal; Imamović, Goran; Trnacević, Senaid

    2009-01-01

    The aim of the study was to compare ultrasound findings of kidneys in children and adolescents with diabetes mellitus type 1 (DMT1), establish the association with microalbuminuria, blood pressure values and metabolic control of the disease, and creatinine clearance. In 80 children and adolescents with DMT1, in whom illness occurred in period between 2 and 16 years of age, morphometry measurements with ultrasound were performed. Nephelometric method of three consecutive samples of urine determined microalbuminuria. In patients with microalbuminuria, creatinine clearance was also measured. Demographic data were obtained from the parents and from the patients medical records. In relation to the duration of the disease, all patients were divided into two groups: the first group of patients with illness lasting for less than 10 years, and the second were those whose illness had lasted more than 10 years. In patients with duration of DMT1 of more than 10 years, the frequency of pathological findings of the longitudinal diameter and volume of both kidneys in relation to age and anthropometric standards was statistically significantly greater. Also, the finding of microalbuminuria was more frequent. In the group of patients with DMT1 lasting for more than 10 years, the mean value of HBA1c was statistically significantly higher In patients with microalbuminuria the total mean value of creatinine clearance was within the bounds of the reference values and was statistically significantly higher in patients in whom the illness had lasted less than three years, which indicates hyperfiltration of the kidneys. Alongside microalbuminuria, monitoring of the dimension and volume of the kidneys may indicate the existence of the early phases of diabetic nephropathy and result in its prevention and prevention of illness progression.

  18. Development of an affordable dye-stained microalbuminuria screening test.

    PubMed

    Tugirimana, Pierrot Lundimu; Delanghe, Joris R

    2009-05-01

    A simple spot test was developed, which allows quantification of microalbuminuria. Evaluation was carried out according to the ISO 15189 guidelines. Urine was spotted on cellulose acetate strips and stained using different sensitive protein binding dyes (nigrosin, Coomassie Blue R-250, amido black). The colour intensity of the stained spots was quantified using a Kodak Image 450 station. Analytical sensitivity of the Coomassie Blue based method (18 mg/L) was better than that for nigrosin (50 mg/ L) or amido black (100 mg/L) based methods. Within-run coefficient of variation (CV) and between-run CV of the Coomassie blue assay were, respectively, 8.4% and 9.7% (50 mg/L), and 3% and 4.5% (400 mg/L). For nigrosin, these data were, respectively, 8.4 and 9.4 (50 mg/L), and 3.4 and 6.4% (400 mg/L). Coomassie Blue showed a preferential binding selectivity towards albumin. The method was found to be linear between 20 and 600 mg/L. A good correlation (r2 = 0.89) was obtained between Coomassie Blue based and immunonephelometric measurements. Immuno-unreactive albumin (prepared by protease treatment) could be detected by the spot test, which offers an advantage of the method versus immunochemical tests. Ammonium sulphate precipitation could further increase the specificity of the assay by eliminating effects of free light chains. The described method is very simple and extremely cheap, which makes it potentially suited for screening programmes, particularly in third world countries.

  19. Epidemiological Issues in Diabetic Retinopathy

    PubMed Central

    Scanlon, Peter H; Aldington, Stephen J; Stratton, Irene M

    2013-01-01

    There is currently an epidemic of diabetes in the world, principally type 2 diabetes that is linked to changing lifestyle, obesity, and increasing age of the population. Latest estimates from the International Diabetes Federation (IDF) forecasts a rise from 366 million people worldwide to 552 million by 2030. Type 1 diabetes is more common in the Northern hemisphere with the highest rates in Finland and there is evidence of a rise in some central European countries, particularly in the younger children under 5 years of age. Modifiable risk factors for progression of diabetic retinopathy (DR) are blood glucose, blood pressure, serum lipids, and smoking. Nonmodifiable risk factors are duration, age, genetic predisposition, and ethnicity. Other risk factors are pregnancy, microaneurysm count in an eye, microaneurysm formation rate, and the presence of any DR in the second eye. DR, macular edema (ME), and proliferative DR (PDR) develop with increased duration of diabetes and the rates are dependent on the above risk factors. In one study of type 1 diabetes, the median individual risk for the development of early retinal changes was 9.1 years of diabetes duration. Another study reported the 25 year incidence of proliferative retinopathy among population-based cohort of type 1 patients with diabetes was 42.9%. In recent years, people with diabetes have lower rates of progression than historically to PDR and severe visual loss, which may reflect better control of glucose, blood pressure, and serum lipids, and earlier diagnosis. PMID:24339678

  20. Animal Models of Diabetic Retinopathy.

    PubMed

    Olivares, Ana Maria; Althoff, Kristen; Chen, Gloria Fanghua; Wu, Siqi; Morrisson, Margaux A; DeAngelis, Margaret M; Haider, Neena

    2017-08-24

    Diabetic retinopathy (DR) is one of the most common complications associated with chronic hyperglycemia seen in patients with diabetes mellitus. While many facets of DR are still not fully understood, animal studies have contributed significantly to understanding the etiology and progression of human DR. This review provides a comprehensive discussion of the induced and genetic DR models in different species and the advantages and disadvantages of each model. Rodents are the most commonly used models, though dogs develop the most similar morphological retinal lesions as those seen in humans, and pigs and zebrafish have similar vasculature and retinal structures to humans. Nonhuman primates can also develop diabetes mellitus spontaneously or have focal lesions induced to simulate retinal neovascular disease observed in individuals with DR. DR results in vascular changes and dysfunction of the neural, glial, and pancreatic β cells. Currently, no model completely recapitulates the full pathophysiology of neuronal and vascular changes that occur at each stage of diabetic retinopathy; however, each model recapitulates many of the disease phenotypes.

  1. Retinopathy and Chronic Kidney Disease in the Chronic Renal Insufficiency Cohort Study (CRIC)

    PubMed Central

    Grunwald, Juan E.; Alexander, Judith; Ying, Gui-Shuang; Maguire, Maureen; Daniel, Ebenezer; Whittock-Martin, Revell; Parker, Candace; McWilliams, Kathleen; Lo, Joan C.; Go, Alan; Townsend, Raymond; Gadegbeku, Crystal A.; Lash, James P.; Fink, Jeffrey C.; Rahman, Mahboob; Feldman, Harold; Kusek, John W.; Xie, Dawei; Jaar, Bernard G.

    2013-01-01

    Objectives Retinal vascular and anatomic abnormalities caused by diabetes, hypertension, and other conditions can be observed directly in the ocular fundus and may reflect severity of chronic renal insufficiency. The purpose of this study was to investigate the association between retinopathy and chronic kidney disease (CKD). Methods In this observational, cross-sectional study, 2605 participants of the Chronic Renal Insufficiency Cohort (CRIC) study, a multi-center study of CKD, were offered participation. Non-mydriatic fundus photographs of the disc and macula in both eyes were obtained in 1936 of these subjects. Photographs were reviewed in a masked fashion at a central photograph reading center using standard protocols. Presence and severity of retinopathy (diabetic, hypertensive or other) and vessel diameter caliber were assessed by trained graders and a retinal specialist using protocols developed for large epidemiologic studies. Kidney function measurements and information on traditional and non-traditional risk factors for decreased kidney function were obtained from the CRIC study. Results Greater severity of retinopathy was associated with lower estimated glomerular filtration rate (eGFR) after adjustment for traditional and non-traditional risk factors. Presence of vascular abnormalities usually associated with hypertension was also associated with lower eGFR. We found no strong direct relationship between eGFR and average arteriolar or venular calibers. Conclusions Our findings show a strong association between severity of retinopathy and its features and level of kidney function after adjustment for traditional and non-traditional risk factors for CKD, suggesting that retinovascular pathology reflects renal disease. PMID:22965589

  2. The Danish Registry of Diabetic Retinopathy

    PubMed Central

    Andersen, Nis; Hjortdal, Jesper Østergaard; Schielke, Katja Christina; Bek, Toke; Grauslund, Jakob; Laugesen, Caroline Schmidt; Lund-Andersen, Henrik; Cerqueira, Charlotte; Andresen, Jens

    2016-01-01

    Aim of database To monitor the development of diabetic eye disease in Denmark and to evaluate the accessibility and effectiveness of diabetic eye screening programs with focus on interregional variations. Target population The target population includes all patients diagnosed with diabetes. Denmark (5.5 million inhabitants) has ~320,000 diabetes patients with an annual increase of 27,000 newly diagnosed patients. The Danish Registry of Diabetic Retinopathy (DiaBase) collects data on all diabetes patients aged ≥18 years who attend screening for diabetic eye disease in hospital eye departments and in private ophthalmological practice. In 2014–2015, DiaBase included data collected from 77,968 diabetes patients. Main variables The main variables provide data for calculation of performance indicators to monitor the quality of diabetic eye screening and development of diabetic retinopathy. Data with respect to age, sex, best corrected visual acuity, screening frequency, grading of diabetic retinopathy and maculopathy at each visit, progression/regression of diabetic eye disease, and prevalence of blindness were obtained. Data analysis from DiaBase’s latest annual report (2014–2015) indicates that the prevalence of no diabetic retinopathy, nonproliferative diabetic retinopathy, and proliferative diabetic retinopathy is 78%, 18%, and 4%, respectively. The percentage of patients without diabetic maculopathy is 97%. The proportion of patients with regression of diabetic retinopathy (20%) is greater than the proportion of patients with progression of diabetic retinopathy (10%). Conclusion The collection of data from diabetic eye screening is still expanding in Denmark. Analysis of the data collected during the period 2014–2015 reveals an overall decrease of diabetic retinopathy compared to the previous year, although the number of patients newly diagnosed with diabetes has been increasing in Denmark. DiaBase is a useful tool to observe the quality of screening

  3. The Danish Registry of Diabetic Retinopathy.

    PubMed

    Andersen, Nis; Hjortdal, Jesper Østergaard; Schielke, Katja Christina; Bek, Toke; Grauslund, Jakob; Laugesen, Caroline Schmidt; Lund-Andersen, Henrik; Cerqueira, Charlotte; Andresen, Jens

    2016-01-01

    To monitor the development of diabetic eye disease in Denmark and to evaluate the accessibility and effectiveness of diabetic eye screening programs with focus on interregional variations. The target population includes all patients diagnosed with diabetes. Denmark (5.5 million inhabitants) has ~320,000 diabetes patients with an annual increase of 27,000 newly diagnosed patients. The Danish Registry of Diabetic Retinopathy (DiaBase) collects data on all diabetes patients aged ≥18 years who attend screening for diabetic eye disease in hospital eye departments and in private ophthalmological practice. In 2014-2015, DiaBase included data collected from 77,968 diabetes patients. The main variables provide data for calculation of performance indicators to monitor the quality of diabetic eye screening and development of diabetic retinopathy. Data with respect to age, sex, best corrected visual acuity, screening frequency, grading of diabetic retinopathy and maculopathy at each visit, progression/regression of diabetic eye disease, and prevalence of blindness were obtained. Data analysis from DiaBase's latest annual report (2014-2015) indicates that the prevalence of no diabetic retinopathy, nonproliferative diabetic retinopathy, and proliferative diabetic retinopathy is 78%, 18%, and 4%, respectively. The percentage of patients without diabetic maculopathy is 97%. The proportion of patients with regression of diabetic retinopathy (20%) is greater than the proportion of patients with progression of diabetic retinopathy (10%). The collection of data from diabetic eye screening is still expanding in Denmark. Analysis of the data collected during the period 2014-2015 reveals an overall decrease of diabetic retinopathy compared to the previous year, although the number of patients newly diagnosed with diabetes has been increasing in Denmark. DiaBase is a useful tool to observe the quality of screening, prevalence, and progression/regression of diabetic eye disease.

  4. Diabetic Retinopathy and Diabetic Macular Edema.

    PubMed

    Cohen, Steven R; Gardner, Thomas W

    2016-01-01

    Diabetic retinopathy and diabetic macular edema result from chronic damage to the neurovascular structures of the retina. The pathophysiology of retinal damage remains uncertain but includes metabolic and neuroinflammatory insults. These mechanisms are addressed by intensive metabolic control of the systemic disease and by the use of ocular anti-inflammatory agents, including vascular endothelial growth factor inhibitors and corticosteroids. Improved understanding of the ocular and systemic mechanisms that underlie diabetic retinopathy will lead to improved means to diagnose and treat retinopathy and better maintain vision.

  5. Polyunsaturated fatty acids and diabetic retinopathy.

    PubMed Central

    Howard-Williams, J; Patel, P; Jelfs, R; Carter, R D; Awdry, P; Bron, A; Mann, J I; Hockaday, T D

    1985-01-01

    One hundred and forty nine diabetic patients were ophthalmologically assessed seven years after randomisation to a low carbohydrate or modified fat diet (rich in linoleic acid). Glycaemic control, regardless of the type of diet, was a major determinant of the development of retinopathy. Poorly controlled patients (haemoglobin A1c greater than 8%) with low levels of linoleic acid in cholesterol ester had a significantly greater frequency of retinopathy than well controlled patients or patients with similarly unsatisfactory control but higher levels of linoleic acid. The findings support an earlier suggestion that linoleic acid might protect against diabetic retinopathy. PMID:3965024

  6. Diabetic Retinopathy: Recent Updates on Different Biomarkers and Some Therapeutic Agents.

    PubMed

    Khan, Amjad Ali; Rahmani, Arshad Husain; Aldebasi, Yousef Homood

    2017-09-15

    Diabetic Retinopathy is a leading cause of sight-threatening complication, which occurs due to a number of physiological and metabolic abnormalities during later stages of diabetes. Many of these abnormal changes are consistent with altered oxidative stress, inflammation, genetic set up, advanced glycation end products, and hematological changes. So the altered levels of different biomolecules related to these changes serve as important biomarkers to assess better evaluation and early treatment of this disease. Some treatments like laser therapy may be fast and specific but are more expensive, limited and can result in severe contraindications. Several other novel treatment strategies have been evolved recently besides classical approaches like control over hyperglycemia, hypertension, lipid profile to control diabetic retinopathy. These precise treatments are based on targeting the elevated biomarkers in retina. Such treatments include use of anti-VEGF therapy, intravitreal corticosteroids, gamigliptin and flavonoids. The present review discusses the latest updates on diabetic retinopathy, common etiology, different biomarkers and current treatments. In conclusion, perfection and proper supervision of diabetes and early treatment of diabetic retinopathy is crucial in controlling the occurrence and severity of this disease. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

  7. Prevalence of microalbuminuria and its correlates among diabetic patients attending diabetic clinic at National Guard Hospital in Alhasa

    PubMed Central

    AlFehaid, Aneesah A.

    2017-01-01

    INTRODUCTION: Diabetes mellitus is one of the most common diseases encountered in clinical practice. Diabetic nephropathy is a common consequence of long-standing diabetes mellitus; microalbuminuria (MA) is considered an early stage of diabetic nephropathy. OBJECTIVES: To determine the prevalence of miciroalbuminuria in diabetic patients and factors associated with MA. MATERIALS AND METHODS: This cross-sectional study was conducted in the diabetic clinic of the primary health center of the National Guard Hospital. Diabetes type 2 patients between the ages of 20–60 years who attended the clinic in 2012 were included in this study. Data were collected by reviewing medical records for demographic and disease-related variables. MA was detected by measuring the albumin to creatinine ratio, and MA was diagnosed if this ratio was between 30 and 300 mg/g on two occasions. RESULTS: MA was found in 37.4% of the sample and the rate was significantly higher among females (P < 0.027). MA was positively related to body mass index (BMI) (P < 0.002), the presence of hypertension (P < 0.000), duration of diabetes (P < 0.000), glycated hemoglobin (P < 0.000), fasting plasma glucose (P < 0.000), and low-density lipoprotein (LDL) (P < 0.043). No statistically significant correlation was found between MA and age, creatinine level, high-density lipoprotein, and triglyceride. CONCLUSION: The prevalence of MA in patients with diabetes in this study was high. The study suggests the need to screen for MA early, and the active management of modifiable risk factors, in particular, hyperglycemia, hypertension, LDL, and BMI, to reduce the burden of future end-stage renal disease. PMID:28163568

  8. A study of the 3-year incidence of diabetic retinopathy in a French diabetic population seen at Lariboisière Hospital, Paris.

    PubMed

    Perol, J; Balkau, B; Guillausseau, P-J; Massin, P

    2012-06-01

    This study evaluated the incidence of diabetic retinopathy (DR) over a 3-year period in a French population that was followed by OPHDIAT®, and assessed the clinical and biological risk factors associated with incident retinopathy. The studied patients were screened for DR during hospitalization for their annual diabetes check-up in the endocrinology department by two examinations three years apart. DR screening used the OPHDIAT® telemedical network, and the examination included clinical and biological data. A total of 254 patients were studied. At the 3-year follow-up, the incidence was 14.0%, (CI: 9.5-18.4%). Longer duration of diabetes and the presence of micro- or macroalbuminuria were significantly associated with incident retinopathy (P<0.05). Other potential risk factors were not statistically significantly related to DR progression, and only treatment with insulin showed a trend towards significance (P<0.20). This study provides the first French data on the incidence of DR, which was estimated after a 3-year follow-up at 14.0%. Longer duration of time from the onset of diabetes and higher baseline albuminuria were the only statistically significant risk factors found for the incidence of DR after our 3-year study. Nevertheless, microalbuminuria should be more widely used in ophthalmological practice in the assessment of DR, as is already the case for both blood pressure and HbA(1c). Copyright © 2012 Elsevier Masson SAS. All rights reserved.

  9. Continued Reduction in the Prevalence of Retinopathy in Adolescents With Type 1 Diabetes

    PubMed Central

    Downie, Elizabeth; Craig, Maria E.; Hing, Stephen; Cusumano, Janine; Chan, Albert K.F.; Donaghue, Kim C.

    2011-01-01

    OBJECTIVE To examine trends in microvascular complications in adolescents with type 1 diabetes between 1990 and 2009 in Sydney, Australia. RESEARCH DESIGN AND METHODS We used analysis of complications in 1,604 adolescents (54% female, aged 12–20 years, median duration 8.6 years), stratified by four time periods using Generalized Estimation Equations as follows: T1 (1990–1994), T2 (1995–1999), T3 (2000–2004), and T4 (2005–2009). Early retinopathy was detected using seven-field fundal photography, albumin excretion rate (AER) using timed overnight urine collections, and albumin-to-creatinine ratio (ACR) and peripheral nerve function using thermal and vibration threshold. RESULTS Retinopathy declined (53, 38, 23, and 12%; P < 0.001), as did borderline elevation of AER/ACR (45, 30, 26, and 30%; P < 0.001) and microalbuminuria (8, 4, 3, and 3%; P = 0.006). Multiple daily injections (MDI)/continuous subcutaneous insulin infusion (CSII) use increased (17, 54, 75, and 88%; P < 0.001), median HbA1c decreased (9.1, 8.9, 8.5, and 8.5%; P < 0.001), and severe hypoglycemia was unchanged (6, 8, 10, and 7%; P = 0.272). Retinopathy was associated with diabetes duration (odds ratio [OR] 1.12 [95% CI 1.08–1.17]), age (1.13 [1.06–1.20]), HbA1c (1.16 [1.08–1.25]), systolic blood pressure (BP) SDS (1.31 [1.16–1.48]), socioeconomic disadvantage (1.42 [1.04–1.95]), and 1 to 2 injections per day (vs. MDI/CSII; 1.35 [1.05–1.73]); borderline AER/ACR with male sex (1.32 [1.02–1.70]), age (1.19 [1.12–1.26]), HbA1c (1.18 [1.08–1.29]), weight SDS (1.31 [1.21–1.53]), insulin dose per kilograms (1.64 [1.13–2.39]), 1 to 2 injections per day (1.41 [1.08–1.84]), and socioeconomic disadvantage (1.68 [1.23–2.31]); and microalbuminuria with age (1.14 [1.01–1.29]), HbA1c (1.20 [1.05–1.37]), diastolic BP SDS (1.76 [1.26–2.46]), and 1 to 2 injections per day (1.95 [1.11–3.41]). CONCLUSIONS The decline in retinopathy supports contemporary guidelines that

  10. [Arterial hypertension and obesity--a dangerous combination].

    PubMed

    Zakharieva, S

    1999-01-01

    The combination of obesity with arterial hypertension is frequent finding in clinical practice. In 70% of the males and 61% of the females the high blood pressure is directly connected with obesity. The assumed mechanisms by which obesity leads to arterial hypertension are: insuline resistance; genetic factors (hypothesis for the sparing gene); correlations leptin-neuropeptide Y; fatty tissue as origin of local pressor and depressor humoral factors. The arterial hypertension in obesity is salt-sensible, associated with increased intraglomerular pressure, microalbuminuria and increased risk for cardiovascular complications. The reduction of the body weight is the principal nonmedical mean for treatment of the arterial hypertension. Of the antihypertensive drugs those which are neutral with respect to the carbohydrat and fat metabolism are preferred inhibitors of the converting enzyme, calcium antagonists, selective alpha-1 blockers, central alpha-2 agonist.

  11. Prevalence and Correlates of Microalbuminuria in Children with Sickle Cell Anaemia: Experience in a Tertiary Health Facility in Enugu, Nigeria

    PubMed Central

    Eke, Christopher Bismarck; Okafor, Henrietta Uche; Ibe, Bede Chidozie

    2012-01-01

    Microalbuminuria is a pre-clinical marker of renal damage in children with sickle cell anaemia and can predict renal failure. Reported prevalence rates increased with age. In Nigeria, burden of disease and prevailing poor health facilities necessitate its screening, determination of prevalence and associated risk factors. It is a cross-sectional as well as descriptive study. Screening microalbuminuria used subjects' early morning urine. Socio-demographic as well as clinical details were ascertained using semi-structured questionnaires and case files. Associations and statistical relationship of prevalence rates and clinical/epidemiological data were ascertained using chi-squared and multivariate analysis (P < 0.05). Two hundred children with sickle cell anaemia (4–17 years) in steady state and 200 age/gender-matched controls were enrolled. Prevalence of microalbuminuria was ,respectively, 18.5% and 2.5% for subjects and controls (P = 0.001). Microalbuminuria was commoner in females (19.8%) than males (17.4%) P = 0.70, increased with age (P = 0.016), significantly associated with haemoglobin level (P = 0.002) and hospitalizations (0.001). Subjects had normal renal function. Hospitalizations and haemoglobin levels showed statistical significance on multivariate analysis. Prevalence of microalbuminuria is 18.5%. Age, haemoglobin concentrations, and higher hospitalizations influenced microalbuminuria among subjects. Screening for microalbuminuria should be incorporated in the case management of subjects with identified risk factors. PMID:23056942

  12. Solar retinopathy without abnormal exposure: case report.

    PubMed

    Stock, Ricardo Alexandre; Savaris, Simone Louise; de Lima Filho, Erasmo Carlos Rodrigues; Bonamigo, Elcio Luiz

    2013-01-01

    Solar retinopathy is photochemical damage to the retina, usually caused, by direct or indirect solar observation resulting from the use of hallucinogenic drugs, mental disorders or during eclipses. There may be a loss of visual acuity. We report the case of a 38-year-old patient who presented with a clinical diagnosis of solar retinopathy in the left eye, no prior history of sun exposure, normal visual acuity and complaints of metamorphopsia. Optical coherence tomography showed a rupture of the retinal pigment epithelium, confirming class II solar retinopathy. Visual acuity tends to normalize after 3 to 9 months, but not always. Thus, there is a real need to educate people about using eye protection during sun exposure especially given that some people may be highly susceptible to retinal damage, which was presumably the case for this patient. Finally, we note the importance of optical coherence tomography in diagnosing solar retinopathy.

  13. [Proliferative diabetic retinopathy -- therapeutic approach (clinical case)].

    PubMed

    Burcea, M; Muşat, Ovidiu; Mahdi, Labib; Gheorghe, Andreea; Spulbar, F; Gobej, I

    2014-01-01

    We present the case of a 54 year old pacient diagnosed with neglected insulin dependent diabetes and proliferative diabetic retinopathy. Surgery was recommended and we practiced posterior vitrectomy, endolaser and heavy silicone oil endotamponade. Post-operative evolution was favorable.

  14. [Pathogenesis of retinopathy of prematurity].

    PubMed

    Stahl, A; Lagrèze, W A; Agostini, H T

    2012-12-01

    Retinopathy of prematurity (ROP) is a complex disease with a multifactorial pathogenetic cascade that is still only partially understood. Important pathogenetic factors are gestational age at birth and birth weight. Potent postnatal factors are exposure to supplemental oxygen, slow weight gain and expression of angiogenic growth factors. Some of these crucial aspects of ROP pathogenesis will be discussed in this article and put into clinical context. With the introduction of intravitreal anti-VEGF (vascular endothelial growth factor) treatment into ROP therapy, the pathomechanistic role of VEGF in ROP deserves a special focus. Apart from VEGF, other factors will be discussed that may precede VEGF upregulation and thus may represent targets for an earlier and potentially protective intervention. Among these insulin-like growth factor 1 (IGF-1) appears to be most prominent. Finally, factors such as postnatal weight gain will be discussed in light of their potential role as screening parameters and their ability to predict ROP severity.

  15. Automated static perimetry to evaluate diabetic retinopathy.

    PubMed Central

    Federman, J L; Lloyd, J

    1984-01-01

    The Octopus automated static perimeter was used to evaluate patients with early diabetic retinopathy. It showed islands of threshold sensitivity depression that were equal to areas of nonperfusion seen on fluorescein angiography. The geographic area of the fundus at risk of developing these field defects was found to be between 20 and 45 degrees, representing the central area of the midperiphery. This procedure has potential as an excellent screening test for early diabetic retinopathy. Images FIGURE 1 (Cont'd) C PMID:6549516

  16. White coat hypertension in pediatrics.

    PubMed

    Jurko, Alexander; Minarik, Milan; Jurko, Tomas; Tonhajzerova, Ingrid

    2016-01-15

    The article summarizes current information on blood pressure changes in children during clinic visit. White coat as a general dressing of physicians and health care personnel has been widely accepted at the end of the 19th century. Two problems can be associated with the use of white coat: white coat phenomenon and white coat hypertension. Children often attribute pain and other unpleasant experience to the white coat and refuse afterwards cooperation with examinations. Definition of white coat hypertension in the literature is not uniform. It has been defined as elevated blood pressure in the hospital or clinic with normal blood pressure at home measured during the day by ambulatory blood pressure monitoring system. White coat effect is defined as temporary increase in blood pressure before and during visit in the clinic, regardless what the average daily ambulatory blood pressure values are. Clinical importance of white coat hypertension is mainly because of higher risk for cardiovascular accidents that are dependent on end organ damage (heart, vessels, kidney). Current data do not allow any clear recommendations for the treatment. Pharmacological therapy is usually started in the presence of hypertrophic left ventricle, changes in intimal/medial wall thickness of carotic arteries, microalbuminuria and other cardiovascular risk factors. Nonpharmacological therapy is less controversial and certainly more appropriate. Patients have to change their life style, need to eliminate as much cardiovascular risk factors as possible and sustain a regular blood pressure monitoring.

  17. Antisense Oligonucleotide Therapy in Diabetic Retinopathy

    PubMed Central

    Hnik, Peter; Boyer, David S.; Grillone, Lisa R.; Clement, John G.; Henry, Scott P.; Green, Ellen A.

    2009-01-01

    Diabetic retinopathy is one of the leading causes of blindness in the United States and other parts of the world. Historically, laser photocoagulation and vitrectomy surgery have been used for the treatment of diabetic retinopathy, including diabetic macular edema. Both procedures have proven to be useful under certain conditions but have their limitations. New pathways and processes that promote diabetic retinopathy have been identified, and several new therapeutic approaches are under investigation. These new therapies may be beneficial in the treatment of diabetic retinopathy and include antivascular endothelial growth factor agents, corticosteroids, and therapies that may potentially target a number of additional diabetic retinopathy-related factors and processes, including antisense oligonucleotides. Second-generation antisense oligonucleotides, such as iCo-007, may offer a significant advantage in the treatment of diabetic retinopathy by downregulating the signal pathways of multiple growth factors that seem to play a critical role in the process of ocular angiogenesis and vascular leakage. Benefits of such molecules are expected to include the specificity of the kinase target and an extended half-life, resulting in less frequent intravitreal drug administration, resistance to molecule degradation, and a good safety profile. PMID:20144342

  18. Diabetic retinopathy screening using deep neural network.

    PubMed

    Ramachandran, Nishanthan; Hong, Sheng Chiong; Sime, Mary J; Wilson, Graham A

    2017-09-07

    There is a burgeoning interest in the use of deep neural network in diabetic retinal screening. To determine whether a deep neural network could satisfactorily detect diabetic retinopathy that requires referral to an ophthalmologist from a local diabetic retinal screening programme and an international database. Retrospective audit. Diabetic retinal photos from Otago database photographed during October 2016 (485 photos), and 1200 photos from Messidor international database. Receiver operating characteristic curve to illustrate the ability of a deep neural network to identify referable diabetic retinopathy (moderate or worse diabetic retinopathy or exudates within one disc diameter of the fovea). Area under the receiver operating characteristic curve, sensitivity and specificity. For detecting referable diabetic retinopathy, the deep neural network had an area under receiver operating characteristic curve of 0.901 (95% confidence interval 0.807-0.995), with 84.6% sensitivity and 79.7% specificity for Otago and 0.980 (95% confidence interval 0.973-0.986), with 96.0% sensitivity and 90.0% specificity for Messidor. This study has shown that a deep neural network can detect referable diabetic retinopathy with sensitivities and specificities close to or better than 80% from both an international and a domestic (New Zealand) database. We believe that deep neural networks can be integrated into community screening once they can successfully detect both diabetic retinopathy and diabetic macular oedema. © 2017 Royal Australian and New Zealand College of Ophthalmologists.

  19. Prevalence and factors associated with diabetic retinopathy among diabetic patients at Arbaminch General Hospital, Ethiopia: Cross sectional study

    PubMed Central

    Chisha, Yilma; Terefe, Wondwossen; Assefa, Huruy; Lakew, Serawit

    2017-01-01

    Background Currently 93 million people are estimated as living with diabetic retinopathy worldwide. The prevalence and risk factors of diabetic retinopathy in developed countries have been well documented; but in Ethiopia, data on prevalence and associated factors of diabetic retinopathy is lacking. Objective To determine prevalence and factors associated with development of diabetic retinopathy among diabetic patients at Arbaminch General Hospital, Ethiopia. Method Cross-sectional study design with record review of 400 diabetic patients was conducted at Arbaminch General Hospital from November to January 2015. Among 400 diabetic patients, 270 patients with baseline information and without history of hypertension at baseline were included in this study. But patients with gestational diabetes and with retinopathy at baseline were excluded from the study. Consecutive sampling technique was applied to select study participants. Data of cohorts was extracted from medical record using pre tested structured extraction check list. Data cleaning, coding, categorizing, merging and analysis carried out by STATA version 12. Descriptive statistics was done and presented accordingly. Bivariate binary logistic regression analysis was done to select potential candidates for the full model at P-value cutoff point ≤ 0.25 and multivariable binary logistic regression analysis was made to estimate the independent effect of predictors on the occurrence of diabetic retinopathy. Model diagnostic tests were done, final model fitness was checked using Hosmer and Lemeshow chi square test. Finally, statistical significance was tested at P-value <0.05. Result Prevalence of diabetic retinopathy among diabetic patients at Arbaminch General Hospital was 13%. Adjusted analysis showed that the odds of diabetic retinopathy were statistically and significantly associated with baseline age (AOR = 6.06: 95%CI; 2.42, 15.21), baseline systolic blood pressure level (AOR = 4.38: 95%CI; 1.64, 11

  20. Retinopathy and the risk of cardiovascular disease in patients with chronic kidney disease (from the Chronic Renal Insufficiency Cohort study).

    PubMed

    Grunwald, Juan E; Pistilli, Maxwell; Ying, Gui-Shuang; Maguire, Maureen; Daniel, Ebenezer; Whittock-Martin, Revell; Parker-Ostroff, Candace; Mohler, Emile; Lo, Joan C; Townsend, Raymond R; Gadegbeku, Crystal Ann; Lash, James Phillip; Fink, Jeffrey Craig; Rahman, Mahboob; Feldman, Harold; Kusek, John W; Xie, Dawei

    2015-11-15

    Patients with chronic kidney disease (CKD) experience other diseases such as cardiovascular disease (CVD) and retinopathy. The purpose of this study was to assess whether retinopathy predicts future CVD events in a subgroup of the participants of the Chronic Renal Insufficiency Cohort (CRIC) study. In this ancillary investigation, 2,605 participants of the CRIC study were invited to participate, and nonmydriatic fundus photographs were obtained in 1,936 subjects. Using standard protocols, presence and severity of retinopathy (diabetic, hypertensive, or other) and vessel diameter caliber were assessed at a central photograph reading center by trained graders masked to study participant's information. Patients with a self-reported history of cardiovascular disease were excluded. Incident CVD events were adjudicated using medical records. Kidney function measurements, traditional and nontraditional risk factors, for CVD were obtained. Presence and severity of retinopathy were associated with increased risk of development of any CVD in this population of CKD patients, and these associations persisted after adjustment for traditional risk factors for CVD. We also found a direct relation between increased venular diameter and risk of development of CVD; however, the relation was not statistically significant after adjustment for traditional risk factors. In conclusion, the presence of retinopathy was associated with future CVD events, suggesting that retinovascular pathology may be indicative of macrovascular disease even after adjustment for renal dysfunction and traditional CVD risk factors. Assessment of retinal morphology may be valuable in assessing risk of CVD in patients with CKD, both clinically and in research settings.

  1. A Diabetic Retinopathy Screening Tool for Low-Income Adults in Mexico.

    PubMed

    Mendoza-Herrera, Kenny; Quezada, Amado D; Pedroza-Tobías, Andrea; Hernández-Alcaraz, Cesar; Fromow-Guerra, Jans; Barquera, Simón

    2017-10-12

    A national diabetic retinopathy screening program does not exist in Mexico as of 2017. Our objective was to develop a screening tool based on a predictive model for early detection of diabetic retinopathy in a low-income population. We analyzed biochemical, clinical, anthropometric, and sociodemographic information from 1,000 adults with diabetes in low-income communities in Mexico (from 11,468 adults recruited in 2014-2016). A comprehensive ophthalmologic evaluation was performed. We developed the screening tool through the following stages: 1) development of a theoretical predictive model, 2) performance assessment and validation of the model using cross-validation and the area under the receiver operating characteristic curve (AUC ROC), and 3) optimization of cut points for the classification of diabetic retinopathy. We identified points along the AUC ROC that minimized the misclassification cost function and considered various scenarios of misclassification costs and diabetic retinopathy prevalence. Time since diabetes diagnosis, high blood glucose levels, systolic hypertension, and physical inactivity were considered risk factors in our screening tool. The mean AUC ROC of our model was 0.780 (validation data set). The optimized cut point that best represented our study population (z = -0.640) had a sensitivity of 82.9% and a specificity of 61.9%. We developed a low-cost and easy-to-apply screening tool to detect people at high risk of diabetic retinopathy in Mexico. Although classification performance of our tool was acceptable (AUC ROC > 0.75), error rates (precision) depend on false-negative and false-positive rates. Therefore, confirmatory assessment of all cases is mandatory.

  2. Are We on the Path to Solve the Enigma of Resistant Hypertension: Renal Sympathetic Denervation

    PubMed Central

    Gerc, Vjekoslav; Buksa, Marko

    2013-01-01

    Renal sympathetic denervation (RSD) opens new perspectives and possibilities not only in the treatment of resistant hypertension but also of other cardiometabolic diseases. In patients with hypertension, it has been demonstrated that activity of the sympathetic nervous system correlates with grade of hypertension. Decreasing sympathetic activity using RSD significantly reduces blood pressure in resistant hypertension. It is too early to say a definite opinion about appropriateness of this method in the treatment of resistant hypertension, because there are not great studies with huge number of the patients. After we get and evaluate these results through a longer span of time, only than we shall know what is the role of RSD in the treatment of resistant hypertension and other cardiometabolic conditions related to increased function of the sympathetic nervous system, such as heart failure, diabetes mellitus, obstructive sleep apnea, renal disease with microalbuminuria and macroalbuminuria. PMID:25568521

  3. Are we on the path to solve the enigma of resistant hypertension: renal sympathetic denervation.

    PubMed

    Gerc, Vjekoslav; Buksa, Marko

    2013-12-01

    Renal sympathetic denervation (RSD) opens new perspectives and possibilities not only in the treatment of resistant hypertension but also of other cardiometabolic diseases. In patients with hypertension, it has been demonstrated that activity of the sympathetic nervous system correlates with grade of hypertension. Decreasing sympathetic activity using RSD significantly reduces blood pressure in resistant hypertension. It is too early to say a definite opinion about appropriateness of this method in the treatment of resistant hypertension, because there are not great studies with huge number of the patients. After we get and evaluate these results through a longer span of time, only than we shall know what is the role of RSD in the treatment of resistant hypertension and other cardiometabolic conditions related to increased function of the sympathetic nervous system, such as heart failure, diabetes mellitus, obstructive sleep apnea, renal disease with microalbuminuria and macroalbuminuria.

  4. [Retinopathy due to 4-aminoquinolines in the prevention of malaria].

    PubMed

    Vedy, J; Graveline, J; Carrica, J; Rivaud, C; Chanut, G

    1979-01-01

    The authors give a study about retinopathy by 4-amino-quinoleine in malaria prevention. Twelve observations are known in patients after 12 to 20 years of treatment. The authors suggest systematic research of this retinopathy.

  5. Burden of Diabetes Related Complications Among Hypertensive and Non Hypertensive Diabetics: A Comparative Study.

    PubMed

    Kesavamoorthy, Goutham; Singh, Awnish K; Sharma, Shruti; Kasav, Jyoti Bala; Mohan, Surapaneni Krishna; Joshi, Ashish

    2015-09-01

    Diabetes and hypertension are the conditions with overlapping risk factors and complications. Objective of present study was to compare the burden of complications of diabetes among hypertensive and non hypertensive diabetes individuals. This cross-sectional study was conducted at Saveetha medical college and hospital, Chennai, India. A total of 100 diabetics having hypertension and 50 non-hypertensive diabetic patients were enrolled on the basis of purposive sampling. Information about sociodemograpic characteristics, general health, health distress, diabetes symptoms, communication with physician, healthcare utilization and lifetime occurrence of diabetes related complications. Mean, standard deviation and median of continuous variables and proportion of categorical variables were recorded. Average age of the hypertensive diabetes patients (M=57; SD=11) was higher than non hypertensive diabetes patients (M=52; SD=11) which was statistically significant (p=.009). Diabetic neuropathy was reported by 45% of the hypertensive and 38% of the non-hypertensive diabetics. Mean self reported general health score was higher among hypertensive diabetic participants (M=3.4; SD=1) in comparison to non hypertensive diabetic participants (M=3; SD=1) and it was found statistically significant (p=.03) indicating towards poor self health perception among hypertensive's. Results of the study have shown that the proportion of participants who have prepared any list of questions before visiting doctor's clinic (fairly often to always) was significantly higher among hypertensive diabetics (30%) in comparison to non-hypertensive diabetics (14%). The proportion of participants reporting diabetes neuropathy and retinopathy was higher among hypertensive diabetics in comparison to non hypertensive diabetics.

  6. Prevalence of diabetic retinopathy in patients with diabetes mellitus diagnosed after the age of 70 years

    PubMed Central

    Cahill, M; Halley, A; Codd, M; O'Meara, N; Firth, R; Mooney, D; Acheson, R

    1997-01-01

    AIMS/BACKGROUND—A hospital based prevalence study was undertaken to estimate the prevalence of diabetic retinopathy (DR) in patients diagnosed as having diabetes mellitus after the age of 70 years. The prevalence of visually threatening retinopathy at the time of diagnosis of diabetes was also determined. The association between prevalence of DR and duration of diabetes mellitus, mode of treatment, HbA1c levels, presence of hypertension, and sex of patient was examined and a comparison was drawn between this study and earlier prevalence studies of DR in older type II diabetics.
METHODS—Using data on the Irish Diabetic Retinopathy Register located in the Mater Misericordiae Hospital, Dublin, all patients who were diagnosed as having type II diabetes mellitus after the age of 70 years were invited to attend for ophthalmic review. Medical records were examined to determine the duration of diabetes mellitus, mode of treatment, recent HbA1c levels, and the presence of systemic hypertension.
RESULTS—Of the 150 patients examined, 21 (14%) had some form of DR and 10 of these patients (6.6%) had visually threatening retinopathy or previously treated visually threatening retinopathy. Five patients (3.3%) presented with visually threatening retinopathy at the time of diagnosis of diabetes. Those patients with DR had a significantly higher median duration of diabetes (5.0 years) compared with those patients without DR (3.5 years). A significantly higher proportion of patients with DR required treatment with insulin and a correspondingly lower proportion of patients without DR were controlled on diet alone. There was no significant association between prevalence of DR and HbA1c levels, systemic hypertension, or sex of patient. There was a lower overall prevalence of DR in comparison with earlier studies.
CONCLUSIONS—The prevalence of DR in these elderly type II diabetics is lower than that previously reported in patients with type II disease but a small

  7. Ambulatory and home blood pressure monitoring in children and adolescents: diagnosis of hypertension and assessment of target-organ damage.

    PubMed

    Karpettas, Nikos; Nasothimiou, Efthimia; Kollias, Anastasios; Vazeou, Adriani; Stergiou, George S

    2013-04-01

    The prevalence of elevated blood pressure in children and adolescents is more common than previously believed and often represents the early onset of essential hypertension, particularly in adolescents. The definition of hypertension in children is based on distribution criteria and normalcy tables that provide blood pressure percentiles for each measurement method (office, ambulatory and home) according to the individual's age, gender and body size. Owing to the white coat and masked hypertension phenomena, ambulatory blood pressure monitoring is indispensable for the diagnosis of hypertension in children. Home blood pressure monitoring in children has been less well studied, and at present, treatment decisions should not be based solely on such measurements. Hypertension-induced preclinical target-organ damage (mainly echocardiographic left ventricular hypertrophy) is not uncommon in children and should be evaluated in all hypertensive children. Other indices of target-organ damage, such as carotid intima-media thickness, pulse wave velocity and microalbuminuria, remain under investigation in pediatric hypertension.

  8. Serum ionized magnesium levels in type 2 diabetic patients with microalbuminuria or clinical proteinuria.

    PubMed

    Corsonello, A; Ientile, R; Buemi, M; Cucinotta, D; Mauro, V N; Macaione, S; Corica, F

    2000-01-01

    The association between microalbuminuria and magnesium depletion is a controversial issue, and serum ionized magnesium levels have not been previously studied in patients with different grades of diabetic nephropathy. Therefore, the aim of this study was to evaluate circulating ionized magnesium concentrations in patients with non-insulin-dependent diabetes mellitus (NIDDM) and incipient or overt diabetic nephropathy. We measured fasting plasma glucose, creatinine, creatinine clearance estimate, total cholesterol and triglycerides, and serum ionized magnesium (ion-selective electrodes, ISE) in 30 NIDDM patients with urinary albumin excretion rate (UAER) <20 microg/min (normoalbuminuria), 30 NIDDM patients with microalbuminuria (20 < UAER < 200 microg/min), 30 NIDDM patients with clinical proteinuria (UAER >200 microg/min), and 20 healthy subjects. Serum ionized magnesium levels were significantly reduced in diabetic patients when compared to control subjects (0.39 +/- 0.06 vs. 0.58 +/- 0.05 mmol/l, p < 0.001). Moreover, diabetic patients with microalbuminuria or clinical proteinuria showed a significant decrease in serum ionized magnesium with respect to normoalbuminuria group (normoalbuminuria: 0.45 +/- 0. 02 mmol/l; microalbuminuria: 0.36 +/- 0.05 mmol/l, p < 0.001; clinical proteinuria: 0.35 +/- 0.04 mmol/l, p < 0.001). Serum ionized magnesium showed a significant negative correlation with plasma HbA1c and triglycerides in both microalbuminuria and clinical proteinuria groups. Multiple linear regression analysis showed that circulating ionized magnesium levels decrease together with the increase of plasma HbA1c and triglycerides in NIDDM patients with incipient or overt nephropathy, also after adjusting for age, sex, BMI, diabetes duration, systolic and diastolic blood pressure, hypoglycemic therapy, plasma creatinine, creatinine clearance, plasma cholesterol and fasting glucose. Microalbuminuria and clinical proteinuria, as well as poor glycometabolic control

  9. Animal Models of Diabetic Retinopathy.

    PubMed

    Jiang, Xiaoyan; Yang, Lizhu; Luo, Yan

    2015-01-01

    Diabetic retinopathy (DR) is one of today's main causes of blindness in numerous developed countries worldwide. The underlying pathogenesis of DR is complex and not well understood, thus impeding development of specific, effective treatment modalities. Consequently, the use of animal models of DR is of critical importance for investigating the pathogenesis of and treatment for DR. While rats and mice are the most commonly used animal models of DR, the zebrafish now appears to be a promising model. Nonhuman primates and humans have similar eye structures, and both can develop spontaneous diabetes mellitus (DM). Although various traditionally used animal models of DR undergo a number of pathological changes similar to those of human DR, several human variations, e.g. retinal neovascularization, cannot yet be fully mimicked in any existing animal model of DM. Since both the animal models and the methods chosen for inducing DR have great influence on experimental results, a clear understanding of available animal models is vital for planning an experimental design. In this review, we summarize the mechanisms, methodologies and pros and cons of the most commonly used animal models of DR.

  10. Antiangiogenic Therapy for Ischemic Retinopathies

    PubMed Central

    Al-Latayfeh, Motasem; Silva, Paolo S.; Sun, Jennifer K.; Aiello, Lloyd Paul

    2012-01-01

    Neovascularization is a common pathological process in various retinal vascular disorders including diabetic retinopathy (DR), age-related macular degeneration (AMD) and retinal vein occlusion (RVO). The development of neovascular vessels may lead to complications such as vitreous hemorrhage, fibrovascular tissue formation, and traction retinal detachments. Ultimately, irreversible vision loss may result. Various proangiogenic factors are involved in these complex processes. Different antiangiogenic drugs have been formulated in an attempt treat these vascular disorders. One factor that plays a major role in the development of retinal neovascularization is vascular endothelial growth factor (VEGF). Anti-VEGF agents are currently FDA approved for the treatment of AMD and RVO. They are also extensively used as an off-label treatment for diabetic macular edema (DME), proliferative DR, and neovascular glaucoma. However, at this time, the long-term safety of chronic VEGF inhibition has not been extensively evaluated. A large and rapidly expanding body of research on angiogenesis is being conducted at multiple centers across the globe to determine the exact contributions and interactions among a variety of angiogenic factors in an effort to determine the therapeutic potential of antiangiogenic agent in the treatment of a variety of retinal diseases. PMID:22675660

  11. Solar retinopathy: a case report.

    PubMed

    Yeh, L K; Yang, C S; Lee, F L; Hsu, W M; Liu, J H

    1999-12-01

    Sun-gazing is the main cause of solar retinopathy. A 20-year-old inebriated man lying in a park gazed at the sun for approximately three hours at noon. Forty-eight hours after sun-gazing, the patient experienced the symptoms of blurred vision, erythropsia, and central scotoma in the left eye. Visual acuity decreased from 6/6 to 6/60 in the left eye and fundi examinations showed a round, yellowish-white discoid lesion on the left fovea and a smaller one on the right fovea. Fluorescein angiography showed early dye leakage in the fovea of the left eye, that increased gradually in size and became fuzzy at the foveal border in the late phase. A small, central scotoma of the left eye was also found in the visual field test. One month later, the lesion in the fovea of the left eye became smaller and was surrounded by a coarse pigmented halo. Fluorescein angiography showed a window defect in the retinal pigment epithelium. Visual field testing disclosed that the central scotoma persisted, but became smaller. Six months after sun-gazing, a lamellar hole in the fovea of the left eye was detected by optical coherence tomography. The visual acuity was 6/6 in the right eye and 6/60 in the left eye, and was unchanged at the end of the six-month follow-up period.

  12. Soluble urokinase receptor (suPAR) predicts microalbuminuria in patients at risk for type 2 diabetes mellitus.

    PubMed

    Guthoff, Martina; Wagner, Robert; Randrianarisoa, Elko; Hatziagelaki, Erifili; Peter, Andreas; Häring, Hans-Ulrich; Fritsche, Andreas; Heyne, Nils

    2017-01-16

    Early identification of patients at risk of developing diabetic nephropathy is essential. Elevated serum concentrations of soluble urokinase receptor (suPAR) associate with diabetes mellitus and predict onset and loss of renal function in chronic kidney disease. We hypothesize, that suPAR may be an early risk indicator for diabetic nephropathy, preceding microalbuminuria. The relationship of baseline suPAR and incident microalbuminuria was assessed in a prospective long-term cohort of subjects at increased risk for type 2 diabetes (TULIP, n = 258). Association with albuminuria at later stages of disease was studied in a cross-sectional cohort with manifest type 2 diabetes (ICEPHA, n = 266). A higher baseline suPAR was associated with an increased risk of new-onset microalbuminuria in subjects at risk for type 2 diabetes (hazard ratio 5.3 (95% CI 1.1-25.2, p = 0.03) for the highest vs. lowest suPAR quartile). The proportion of subjects with prediabetes at the end of observation was higher in subjects with new-onset microalbuminuria. suPAR consistently correlated with albuminuria in a separate cohort with manifest type 2 diabetes. Elevated baseline suPAR concentrations independently associate with new-onset microalbuminuria in subjects at increased risk of developing type 2 diabetes. suPAR may hence allow for earlier risk stratification than microalbuminuria.

  13. Soluble urokinase receptor (suPAR) predicts microalbuminuria in patients at risk for type 2 diabetes mellitus

    PubMed Central

    Guthoff, Martina; Wagner, Robert; Randrianarisoa, Elko; Hatziagelaki, Erifili; Peter, Andreas; Häring, Hans-Ulrich; Fritsche, Andreas; Heyne, Nils

    2017-01-01

    Early identification of patients at risk of developing diabetic nephropathy is essential. Elevated serum concentrations of soluble urokinase receptor (suPAR) associate with diabetes mellitus and predict onset and loss of renal function in chronic kidney disease. We hypothesize, that suPAR may be an early risk indicator for diabetic nephropathy, preceding microalbuminuria. The relationship of baseline suPAR and incident microalbuminuria was assessed in a prospective long-term cohort of subjects at increased risk for type 2 diabetes (TULIP, n = 258). Association with albuminuria at later stages of disease was studied in a cross-sectional cohort with manifest type 2 diabetes (ICEPHA, n = 266). A higher baseline suPAR was associated with an increased risk of new-onset microalbuminuria in subjects at risk for type 2 diabetes (hazard ratio 5.3 (95% CI 1.1–25.2, p = 0.03) for the highest vs. lowest suPAR quartile). The proportion of subjects with prediabetes at the end of observation was higher in subjects with new-onset microalbuminuria. suPAR consistently correlated with albuminuria in a separate cohort with manifest type 2 diabetes. Elevated baseline suPAR concentrations independently associate with new-onset microalbuminuria in subjects at increased risk of developing type 2 diabetes. suPAR may hence allow for earlier risk stratification than microalbuminuria. PMID:28091558

  14. Managing hypertension in type 2 diabetes mellitus.

    PubMed

    Horr, Samuel; Nissen, Steven

    2016-06-01

    Hypertension is a common problem in the diabetic population with estimates suggesting a prevalence exceeding 60%. Comorbid hypertension and diabetes mellitus are associated with high rates of macrovascular and microvascular complications. These two pathologies share overlapping risk factors, importantly central obesity. Treatment of hypertension is unequivocally beneficial and improves all-cause mortality, cardiovascular mortality, major cardiovascular events, and microvascular outcomes including nephropathy and retinopathy. Although controversial, current guidelines recommend a target blood pressure in the diabetic population of <140/90 mmHg, which is a similar target to that proposed for individuals without diabetes. Management of blood pressure in patients with diabetes includes both lifestyle modifications and pharmacological therapies. This article reviews the evidence for management of hypertension in patients with type 2 diabetes mellitus, and provides a recommended treatment strategy based on the available data. Copyright © 2016 Elsevier Ltd. All rights reserved.

  15. Burden of Diabetes Related Complications Among Hypertensive and Non Hypertensive Diabetics: A Comparative Study

    PubMed Central

    Kesavamoorthy, Goutham; Singh, Awnish K; Sharma, Shruti; Kasav, Jyoti Bala; Joshi, Ashish

    2015-01-01

    Background Diabetes and hypertension are the conditions with overlapping risk factors and complications. Objective of present study was to compare the burden of complications of diabetes among hypertensive and non hypertensive diabetes individuals. Materials and Methods This cross-sectional study was conducted at Saveetha medical college and hospital, Chennai, India. A total of 100 diabetics having hypertension and 50 non-hypertensive diabetic patients were enrolled on the basis of purposive sampling. Information about sociodemograpic characteristics, general health, health distress, diabetes symptoms, communication with physician, healthcare utilization and lifetime occurrence of diabetes related complications. Mean, standard deviation and median of continuous variables and proportion of categorical variables were recorded. Results Average age of the hypertensive diabetes patients (M=57; SD=11) was higher than non hypertensive diabetes patients (M=52; SD=11) which was statistically significant (p=.009). Diabetic neuropathy was reported by 45% of the hypertensive and 38% of the non-hypertensive diabetics. Mean self reported general health score was higher among hypertensive diabetic participants (M=3.4; SD=1) in comparison to non hypertensive diabetic participants (M=3; SD=1) and it was found statistically significant (p=.03) indicating towards poor self health perception among hypertensive’s. Results of the study have shown that the proportion of participants who have prepared any list of questions before visiting doctor’s clinic (fairly often to always) was significantly higher among hypertensive diabetics (30%) in comparison to non-hypertensive diabetics (14%). Conclusion The proportion of participants reporting diabetes neuropathy and retinopathy was higher among hypertensive diabetics in comparison to non hypertensive diabetics. PMID:26500926

  16. Screening Diabetic Retinopathy Through Color Retinal Images

    NASA Astrophysics Data System (ADS)

    Li, Qin; Jin, Xue-Min; Gao, Quan-Xue; You, Jane; Bhattacharya, Prabir

    Diabetic Retinopathy (DR) is a common complication of diabetes that damages the eye's retina. Recognition DR as early as possible is very important to protect patients' vision. We propose a method for screening DR and distin-guishing Prolifetive Diabetic Retinopathy (PDR) from Non-Prolifetive Retino-pathy (NPDR) automatatically through color retinal images. This method evaluates the severity of DR by analyzing the appearnce of bright lesions and retinal vessel patterns. The bright lesions are extracted through morphlogical re-consturction. After that, the retinal vessels are automatically extracted using multiscale matched filters. Then the vessel patterns are analyzed by extracting the vessel net density. The experimental results domonstrate that it is a effective solution to screen DR and distinguish PDR from NPDR by only using color retinal images.

  17. Diabetic retinopathy: hyperglycaemia, oxidative stress and beyond.

    PubMed

    Hammes, Hans-Peter

    2017-09-24

    Diabetic retinopathy remains a relevant clinical problem. In parallel with diagnostic and therapeutic improvements, the role of glycaemia and reactive metabolites causing cell stress and biochemical abnormalities as treatment targets needs continuous re-evaluation. Furthermore, the basic mechanisms of physiological angiogenesis, remodelling and pruning give important clues about the origins of vasoregression during the very early stages of diabetic retinopathy and can be modelled in animals. This review summarises evidence supporting a role for the neurovascular unit-composed of neuronal, glial and vascular cells-as a responder to the biochemical changes imposed by reactive metabolites and high glucose. Normoglycaemic animal models developing retinal degeneration, provide valuable information about common pathways downstream of progressive neuronal damage that induce vasoregression, as in diabetic models. These models can serve to assess novel treatments addressing the entire neurovascular unit for the benefit of early diabetic retinopathy.

  18. Targeting Neovascularization in Ischemic Retinopathy: Recent Advances

    PubMed Central

    Al-Shabrawey, Mohamed; Elsherbiny, Mohamed; Nussbaum, Julian; Othman, Amira; Megyerdi, Sylvia; Tawfik, Amany

    2014-01-01

    Pathological retinal neovascularization (RNV) is a common micro-vascular complication in several retinal diseases including retinopathy of prematurity, diabetic retinopathy, age-related macular degeneration and central vein occlusion. The current therapeutic modalities of RNV are invasive and although they may slow or halt the progression of the disease they are unlikely to restore normal acuity. Therefore, there is an urgent need to develop treatment modalities, which are less invasive and therefore associated with fewer procedural complications and systemic side effects. This review article summarizes our understanding of the pathophysiology and current treatment of RNV in ischemic retinopathies; lists potential therapeutic targets; and provides a framework for the development of future treatment modalities. PMID:25598837

  19. [Relevance of diabetes in high cardiovascular risk hypertensive patients].

    PubMed

    Segura, Julián; de la Sierra, Alejandro; Fernández, Sandra; Ruilope, Luis M

    2013-10-05

    The aim of this cross-sectional study was to compare the prevalence of target organ damage (TOD) and established cardiovascular disease (CVD) in a cohort of nondiabetic hypertensive patients with 3 or more cardiovascular risk factors (CVRF) against a group of hypertensives with type 2 diabetes. We included 4,725 hypertensive patients, 62% male, mean age 64 (SD 12) years, with type 2 diabetes mellitus, independently of the number of associated CVRF (N=2,608), or non-diabetics, in which case we required the presence of 3 CVRF (N=2,117). The prevalence of established CVD (clinical interview) and TOD (left ventricular hypertrophy by electrocardiogram, microalbuminuria and estimated glomerular filtration rate) were estimated. Hypertensive patients with type 2 diabetes had an older age and more marked obesity. Furthermore, these patients showed a higher prevalence of micro- and macroalbuminuria, renal failure, left ventricular hypertrophy, atherosclerotic plaques in carotid arteries and CVD compared with nondiabetic hypertensive patients with 3 or more CVRF. Multivariate analysis showed that the risk of TOD or established CVD were associated independently with the presence of diabetes. Hypertensive patients with type 2 diabetes have a higher prevalence of LOD and CVD compared to nondiabetic hypertensive patients with 3 or more CVRF. Although both situations are included in the high cardiovascular risk stratum, it would be expected an increased incidence of cardiovascular complications in hypertensive diabetic patients. Copyright © 2012 Elsevier España, S.L. All rights reserved.

  20. Urinary albumin excretion in patients with renovascular hypertension.

    PubMed

    Růzicka, M; Stríbrná, J; Englis, M; Lánská, V; Skibová, J; Peregrin, J

    1992-01-01

    Twenty-four hour urinary excretion of albumin (UEalb), IgG and beta-2 microglobulin was investigated at a 3 hour-interval in a control group (C) of healthy subjects, in 30 patients with renovascular hypertension (RVH), and in 16 patients with essential hypertension (EH). Mean UEalb in RVH was significantly higher than in C. A significant direct correlation was demonstrated between diastolic blood pressure and UEalb (p < 0.01). Microalbuminuria (MA) > or = 30 micrograms.min-1 was found in about 18% of RVH patients; it was higher than 16.7 micrograms.min-1 in approx. 31%. These results did not substantially differ from those obtained in patients with EH. The cause for increased UEalb in hypertensive patients may be functional, haemodynamic changes, or structural ones. In either case, MA indicates renal injury, and these patients should be given increased attention when monitoring their blood pressure and when selecting antihypertensive drugs.

  1. Association between retinopathy and cardiovascular disease in patients with chronic kidney disease (from the Chronic Renal Insufficiency Cohort [CRIC] Study).

    PubMed

    Grunwald, Juan E; Ying, Gui-Shuang; Maguire, Maureen; Pistilli, Maxwell; Daniel, Ebenezer; Alexander, Judith; Whittock-Martin, Revell; Parker, Candace; Mohler, Emile; Lo, Joan Chia-Mei; Townsend, Raymond; Gadegbeku, Crystal Ann; Lash, James Phillip; Fink, Jeffrey Craig; Rahman, Mahboob; Feldman, Harold; Kusek, John Walter; Xie, Dawei; Coleman, Martha; Keane, Martin Gerard

    2012-07-15

    Patients with chronic kidney disease experience co-morbid illnesses, including cardiovascular disease (CVD) and retinopathy. The purpose of the present study was to assess the association between retinopathy and self-reported CVD in a subgroup of the participants in the Chronic Renal Insufficiency Cohort study. For this observational, ancillary investigation, 2,605 Chronic Renal Insufficiency Cohort participants were invited to participate in the present study, and nonmydriatic fundus photographs in both eyes were obtained for 1,936 subjects. The photographs were reviewed in a masked fashion at a central photograph reading center. The presence and severity of retinopathy (diabetic, hypertensive, or other) and vessel diameter caliber were assessed using standard protocols by trained graders who were masked to the information about the study participants. A history of self-reported CVD was obtained using a medical history questionnaire. Kidney function measurements and traditional and nontraditional risk factors for CVD were obtained from the Chronic Renal Insufficiency Cohort study. A greater severity of retinopathy was associated with a greater prevalence of any CVD, and this association persisted after adjustment for the traditional risk factors for CVD. The presence of vascular abnormalities usually associated with hypertension was also associated with increased prevalence of CVD. We found a direct relation between CVD prevalence and mean venular caliber. In conclusion, the presence of retinopathy was associated with CVD, suggesting that retinovascular pathology might indicate macrovascular disease, even after adjustment for renal dysfunction and traditional CVD risk factors. This would make the assessment of retinal morphology a valuable tool in CKD studies of CVD outcomes.

  2. MODIFIED BROMOPHENOL BLUE DYE BINDING METHOD FOR QUANTITATION OF MICROALBUMINURIA IN DIABETES MELLITUS.

    PubMed

    Somani, B L; Saha, T K; Arora, M M; Sharma, Y V

    1995-04-01

    Albumin excretion in microalbuminuria range is one of the earliest manifestation of nephropathy, specially in diabetes mellitus. The modified dye binding method using bromo-phenol blue was studied in 27 healthy controls and 54 patients of diabetes mellitus, negative for albuminuria by albustix test. The analytical recovery (99.4 to 104.0%), within run coefficient of variation (0.8 to 0.36%) and day-to-day coefficient of variation (2.39 to 0.82%), for low and higher range were within acceptable limits. The values in controls ranged as follows: urinary albumin concentration (mg/L) 7.7 - 28.4 in 2-hour specimen and 10.3 - 29.2 in overnight specimen; albumin excretion rate (µg/min) 7.8 - 29.7 in 2-hour and 9.2 - 29.6 in overnight specimen; and albumin creatinine ratio (mg/g) 10.6 - 29.6 in 2-hour and 11.9 - 29.6 in overnight specimens. Correlation analysis of various albumin excretion parameters revealed excellent correlation between estimations from overnight and 2-hour samples for albumin-creatinine ratio (r = 1.00) and albumin excretion rate (r=0.96). Equally good correlation was observed between 2-hour albumin-creatinine ratio and albumin excretion rate (r=0.95). In 10 of 54 patients excretion rate was more than 200 µg/min and could have been detected by repeat albustix test. Of the 36 positive for microalbuminuria, 21 had one or more target organ involvement. There was no target organ involvement in 8 patients negative for microalbuminuria. Screening for microalbuminuria by this simple and economic method, using 2-hour albumin-excretion rate or albumin-creatinine ratio could be one of the earliest investigations in diabetic patients.

  3. Urinary MicroRNA Profiling Predicts the Development of Microalbuminuria in Patients with Type 1 Diabetes.

    PubMed

    Argyropoulos, Christos; Wang, Kai; Bernardo, Jose; Ellis, Demetrius; Orchard, Trevor; Galas, David; Johnson, John P

    2015-07-17

    Microalbuminuria provides the earliest clinical marker of diabetic nephropathy among patients with Type 1 diabetes, yet it lacks sensitivity and specificity for early histological manifestations of disease. In recent years microRNAs have emerged as potential mediators in the pathogenesis of diabetes complications, suggesting a possible role in the diagnosis of early stage disease. We used quantiative polymerase chain reaction (qPCR) to evaluate the expression profile of 723 unique microRNAs in the normoalbuminuric urine of patients who did not develop nephropathy (n = 10) relative to patients who subsequently developed microalbuminuria (n = 17). Eighteen microRNAs were strongly associated with the subsequent development of microalbuminuria, while 15 microRNAs exhibited gender-related differences in expression. The predicted targets of these microRNAs map to biological pathways known to be involved in the pathogenesis and progression of diabetic renal disease. A microRNA signature (miR-105-3p, miR-1972, miR-28-3p, miR-30b-3p, miR-363-3p, miR-424-5p, miR-486-5p, miR-495, miR-548o-3p and for women miR-192-5p, miR-720) achieved high internal validity (cross-validated misclassification rate of 11.1%) for the future development of microalbuminuria in this dataset. Weighting microRNA measurements by their number of kidney-relevant targets improved the prognostic performance of the miRNA signature (cross-validated misclassification rate of 7.4%). Future studies are needed to corroborate these early observations in larger cohorts.

  4. Urinary MicroRNA Profiling Predicts the Development of Microalbuminuria in Patients with Type 1 Diabetes

    PubMed Central

    Argyropoulos, Christos; Wang, Kai; Bernardo, Jose; Ellis, Demetrius; Orchard, Trevor; Galas, David; Johnson, John P.

    2015-01-01

    Microalbuminuria provides the earliest clinical marker of diabetic nephropathy among patients with Type 1 diabetes, yet it lacks sensitivity and specificity for early histological manifestations of disease. In recent years microRNAs have emerged as potential mediators in the pathogenesis of diabetes complications, suggesting a possible role in the diagnosis of early stage disease. We used quantiative polymerase chain reaction (qPCR) to evaluate the expression profile of 723 unique microRNAs in the normoalbuminuric urine of patients who did not develop nephropathy (n = 10) relative to patients who subsequently developed microalbuminuria (n = 17). Eighteen microRNAs were strongly associated with the subsequent development of microalbuminuria, while 15 microRNAs exhibited gender-related differences in expression. The predicted targets of these microRNAs map to biological pathways known to be involved in the pathogenesis and progression of diabetic renal disease. A microRNA signature (miR-105-3p, miR-1972, miR-28-3p, miR-30b-3p, miR-363-3p, miR-424-5p, miR-486-5p, miR-495, miR-548o-3p and for women miR-192-5p, miR-720) achieved high internal validity (cross-validated misclassification rate of 11.1%) for the future development of microalbuminuria in this dataset. Weighting microRNA measurements by their number of kidney-relevant targets improved the prognostic performance of the miRNA signature (cross-validated misclassification rate of 7.4%). Future studies are needed to corroborate these early observations in larger cohorts. PMID:26239688

  5. Helicobacter pylori eradication reduces microalbuminuria in type-2 diabetic patients: a prospective study.

    PubMed

    Yanik, Sinan; Doğan, Zeynal; Sarikaya, Murat; Ergul, Bilal; Filik, Levent

    2014-06-01

    To evaluate the effect of Helicobacter Pylori (H. pylori) eradication on microalbuminuria in type 2 diabetic patients. Consecutive patients with dyspepsia, type 2 diabetes mellitus and microalbuminuria were recruited. Upper gastrointestinal endoscopy and rapid urease test (H. pylori fast) were performed for detecting H. pylori infection. Patients with H. pylori infection were given triple treatment. Urea breath tests were performed for all patients after eradication treatment. According to the eradication status, patients were divided into two groups, as H. pylori negative, group 1 (successful eradication group) and H. pylori positive, group 2 (unsuccessful eradication group). Twenty-four hour urine was also collected from all patients at baseline and after H. pylori eradication treatment. A total of 69 patients were included in the study. There were no significant differences between groups for anthropometric measurements and laboratory tests at baseline (p > 0.05). An expected significant difference was found for microlabuminuria and fasting glucose between the two groups. Microalbuminuria and fasting glucose levels were signicantly reduced in the H. pylori negative group compared with the H. pylori positive group after eradication treatment (p < 0.05). Although there was no significant decline in HbA1c levels in the H. pylori negative group, there were relatively lower HbA1c levels compared with baseline for both groups. The rate of attaining normoalbuminuria after eradication was significantly higher in group 1 compared to group 2 (p < 0.05). H. Pylori eradication was found to have a favorable effect on reducing microalbuminuria in diabetic patients.

  6. Segmentation of retinal blood vessels using artificial neural networks for early detection of diabetic retinopathy

    NASA Astrophysics Data System (ADS)

    Mann, Kulwinder S.; Kaur, Sukhpreet

    2017-06-01

    There are various eye diseases in the patients suffering from the diabetes which includes Diabetic Retinopathy, Glaucoma, Hypertension etc. These all are the most common sight threatening eye diseases due to the changes in the blood vessel structure. The proposed method using supervised methods concluded that the segmentation of the retinal blood vessels can be performed accurately using neural networks training. It uses features which include Gray level features; Moment Invariant based features, Gabor filtering, Intensity feature, Vesselness feature for feature vector computation. Then the feature vector is calculated using only the prominent features.

  7. [Diabetic retinopathy complications--12-year retrospective study].

    PubMed

    Ignat, Florica; Davidescu, Livia

    2002-01-01

    It is analyzed, on a retrospective study on 12 years, the incidence of diabetus melitus cases, hospitalized in the Ophthalmologic Clinic from Craiova with special mention to the frequency of the diabetic retinopathy, of it's complications and in an accordance to other general diseases, especially cardiovascular's, which contributes to the aggravation of the diabetic ocular in juries evolution. The study underlines the high incidence of the new founded cases with diabetus melitus in complicated diabetes retinopathy stage; the high frequency of ocular complications is explained, according to our statistic facts and through an insufficient treatment, sometimes incorrect and many other cases total neglected by the patients.

  8. Electro-Oculograms in the Early Diagnosis of Chloroquine Retinopathy

    PubMed Central

    Weinreb, Marvin S.

    1967-01-01

    Funduscopy, electro-oculography and electroretinography are all valuable in early detection of chloroquine retinopathy, which is reversible if detected early. Simplified instrumentation for electro-oculography was utilized in testing 12 normal controls, one patient with diabetic retinopathy and 15 patients with potential or actual cases of chloroquine retinopathy. Normal controls, and all but one of the patients without clinical evidence of retinopathy, had electro-oculographic ratios above 180. All patients having evidence of retinopathy had ratios below 180. ImagesFigure 1.Figure 2. PMID:6039185

  9. Prevalence of Diabetic Retinopathy in Urban Slums: The Aditya Jyot Diabetic Retinopathy in Urban Mumbai Slums Study-Report 2.

    PubMed

    Sunita, Mohan; Singh, Arvind Kumar; Rogye, Ashwini; Sonawane, Manish; Gaonkar, Ravina; Srinivasan, Radhika; Natarajan, Sundaram; Stevens, Fred C J; Scherpbier, A J J A; Kumaramanickavel, Govindasamy; McCarty, Catherine

    2017-10-01

    The aims of the study were to estimate the prevalence of diabetic retinopathy (DR) and enumerate history-based risk factors in the urban slums of Western India. The population-based study was conducted in seven wards of Mumbai urban slums, where we screened 6569 subjects of ≥ 40 years age, with a response rate of 98.4%, for type 2 diabetes mellitus (T2DM) based on American Diabetes Association criteria. All subjects with T2DM underwent dilated 30° seven-field stereo-fundus-photography for DR severity grading based on modified Airlie House classification. A multivariate logistic regression model was used to assess the correlation of DR with the history-based risk factors. The prevalence of DR in the general population of Mumbai urban slums was 1.41% (95% CI 0.59-2.23) and in the T2DM population it was 15.37% (95% CI 8.87-21.87). The positive associations with DR were the longer duration of DM (≥ 11 years: OR, 12.77; 95% CI 2.93-55.61) and male gender (OR, 2.05; 95% CI 1.08-3.89); increasing severity of retinopathy was also significantly associated with longer duration of DM (p < 0.001). However, history of hypertension, family history of DM, consanguineous marriage and migration status were not associated with DR in the study population. The prevalence of DR in the general population and T2DM subjects were 1.41% and 15.37% respectively in Mumbai urban slums. Duration of DM and male gender were significantly associated with DR. The slums in Western India show the trends of urban lifestyle influences similar to the rest of urban India.

  10. Evaluation of Micro-Bumintest reagent tablets for screening of microalbuminuria.

    PubMed

    Tai, J; Tze, W J

    1990-01-01

    The presence of significant microalbuminuria is an important predictor of early diabetic nephropathy. Currently methods available to detect microalbuminuria are not suitable for routine screening. This study assessed the performance of Micro-Bumintest reagent tablets (Ames Laboratory) as a visual screening test for qualitative measurement of urinary albumin. 150 urine specimens from type 1 diabetic patients with a disease duration of less than 1-19 years were assayed over 15 runs using quantitative albumin (radioimmunoassay) and total protein assays. In parallel, 600 determinants were made with the tablets. Each sample was assessed by two readers using a color chart with patterns illustrating typical negative and positive color reactions with a grading from 1 to 7. Urinary protein was determined with an Ames Clinitek 10 urine chemistry analyzer and the Multistix 10 SG reagent strips. The results revealed that as the albumin concentration increased, the percentage of specimens detected visually as presumptive positive (grading = 3) reactions and positive reactions (grading greater than 3) increased. A positive Micro-Bumintest reaction was obtained with an albumin concentration of greater than 40 micrograms/ml. Presumptive positive reactions occur more than 50% of the time at protein concentrations greater than 14 mg/dl. The tablet test is more sensitive than the Clinitek 10/Multistix 10 SG strip system. These data show that the Micro-Bumintest reagent tablets are a sensitive and convenient screening test for detection of microalbuminuria.

  11. [Interferon dysoric retinopathy in chronic viral hepatitis C: case report and literature review].

    PubMed

    Naïja, N; Mohsni, B; Belkahla, N; Maamouri, N; Ben Mami, N

    2014-08-01

    The ophthalmic complications following interferon therapy in chronic hepatitis C are rare. The most common adverse ophthalmic outcome is the dysoric retinopathy characterized by the presence at the fundus examination of cotton wool spots and retinal hemorrhages particularly around the optic disc. A 63-year-old man presented to the hepatology department with a compensated cirrhosis C. His medical history was positive for hypertension controlled by medical treatment. A combined treatment with pegylated interferon α2a plus ribavirin was initiated. Three months later, the patient reported a sudden decreased vision in both eyes. Fundus examination revealed cotton wool spots with retinal hemorrhage. The diagnosis of dysoric retinopathy was established. The antiviral treatment was discontinued. One month later, the patient was asymptomatic and the ocular lesions have disappeared. Dysoric retinopathy is a non-specific complication of interferon therapy in chronic hepatitis C. Despite its good prognosis, a careful fundus examination is required before and during the treatment especially for the patients with risk factors for this adverse event (advanced age, diabetes and high blood pressure). Copyright © 2013 Société nationale française de médecine interne (SNFMI). Published by Elsevier SAS. All rights reserved.

  12. Cross Talk between Lipid Metabolism and Inflammatory Markers in Patients with Diabetic Retinopathy.

    PubMed

    Crosby-Nwaobi, Roxanne; Chatziralli, Irini; Sergentanis, Theodoros; Dew, Tracy; Forbes, Angus; Sivaprasad, Sobha

    2015-01-01

    The purpose of this study was to examine the relationship between metabolic and inflammatory markers in patients with diabetic retinopathy (DR). 208 adult patients with type 2 diabetes participated in this study and were categorized into (1) mild nonproliferative diabetic retinopathy (NPDR) without clinically significant macular edema (CSME), (2) NPDR with CSME, (3) proliferative diabetic retinopathy (PDR) without CSME, and (4) PDR with CSME. Variable serum metabolic markers were assessed using immunoassays. Multinomial logistic regression analysis was performed. Diabetes duration and hypertension are the most significant risk factors for DR. Serum Apo-B and Apo-B/Apo-A ratio were the most significant metabolic risk factors for PDR and CSME. For every 0.1 g/L increase in Apo-B concentration, the risk of PDR and CSME increased by about 1.20 times. We also found that 10 pg/mL increase in serum TNF-α was associated with approximately 2-fold risk of PDR/CSME while an increase by 100 pg/mL in serum VEGF concentration correlated with CSME. In conclusion, it seems that there is a link between metabolic and inflammatory markers. Apo-B/Apo-A ratio should be evaluated as a reliable risk factor for PDR and CSME, while the role of increased systemic TNF-α and VEGF should be explored in CSME.

  13. Cross Talk between Lipid Metabolism and Inflammatory Markers in Patients with Diabetic Retinopathy

    PubMed Central

    Crosby-Nwaobi, Roxanne; Chatziralli, Irini; Sergentanis, Theodoros; Dew, Tracy; Forbes, Angus; Sivaprasad, Sobha

    2015-01-01

    Purpose. The purpose of this study was to examine the relationship between metabolic and inflammatory markers in patients with diabetic retinopathy (DR). Methods. 208 adult patients with type 2 diabetes participated in this study and were categorized into (1) mild nonproliferative diabetic retinopathy (NPDR) without clinically significant macular edema (CSME), (2) NPDR with CSME, (3) proliferative diabetic retinopathy (PDR) without CSME, and (4) PDR with CSME. Variable serum metabolic markers were assessed using immunoassays. Multinomial logistic regression analysis was performed. Results. Diabetes duration and hypertension are the most significant risk factors for DR. Serum Apo-B and Apo-B/Apo-A ratio were the most significant metabolic risk factors for PDR and CSME. For every 0.1 g/L increase in Apo-B concentration, the risk of PDR and CSME increased by about 1.20 times. We also found that 10 pg/mL increase in serum TNF-α was associated with approximately 2-fold risk of PDR/CSME while an increase by 100 pg/mL in serum VEGF concentration correlated with CSME. Conclusions. In conclusion, it seems that there is a link between metabolic and inflammatory markers. Apo-B/Apo-A ratio should be evaluated as a reliable risk factor for PDR and CSME, while the role of increased systemic TNF-α and VEGF should be explored in CSME. PMID:26295054

  14. Advanced glycation end products and diabetic retinopathy.

    PubMed

    Milne, Ross; Brownstein, Seymour

    2013-06-01

    Retinopathy is a serious microvascular complication of diabetes and a major cause of blindness in young adults, worldwide. Early diabetic retinopathy is characterized by a loss of pericytes from retinal capillaries, the appearance of acellular capillaries and microaneurysms, and a breakdown of the blood-retinal barrier. In later stages, this can evolve into the proliferative phase in which there is neovascularization of the retina, which greatly increases the probability of vision loss. Advanced glycation end products (AGEs) which accumulate under hyperglycemic conditions are thought to play an important role in the pathogenesis of diabetic retinopathy. AGEs arise primarily by the modification of amine groups of proteins by reactive dicarbonyls such as methylglyoxal. Intracellular proteins including anti-oxidant enzymes, transcription factors and mitochondrial proteins are targets of dicarbonyl modification and this can modify their functional properties and thus compromise cellular physiology. Likewise, modification of extracellular proteins by dicarbonyls can impair cell adhesion and can generate ligands that can potentially bind to cell surface AGE receptors that activate pro-inflammatory signaling pathways. AGE inhibitors have been shown to provide protection in animal models of diabetic retinopathy and currently are being evaluated in clinical trials.

  15. Secondary Hypertension

    MedlinePlus

    ... conditions that affect your kidneys, arteries, heart or endocrine system. Secondary hypertension can also occur during pregnancy. Secondary ... blood pressure, such as kidney, artery, heart or endocrine system problems. Complications Secondary hypertension can worsen the underlying ...

  16. Hypertension - overview

    MedlinePlus Videos and Cool Tools

    If left untreated, hypertension can lead to the thickening of arterial walls causing its lumen, or blood passage way, to narrow in diameter. ... the narrowed arterial openings. In addition, people with hypertension may be more susceptible to stroke.

  17. Renovascular hypertension

    MedlinePlus

    ... and Rector's The Kidney . 10th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 48. Victor RG. Arterial hypertension. ... eds. Goldman's Cecil Medicine . 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 67. Victor RG. Systemic hypertension: ...

  18. Hypertensive Crisis

    MedlinePlus

    ... Artery Disease Venous Thromboembolism Aortic Aneurysm More Hypertensive Crisis: When You Should Call 9-1-1 for ... 18,2017 Know the two types of HBP crisis to watch for A hypertensive ( high blood pressure ) ...

  19. [Albuminuria after acute oral administration of proteins in patients with renovascular hypertension].

    PubMed

    Stríbrná, J; Růzicka, M; Englis, M; Peregrín, J; Lánská, V

    1993-02-05

    In a group of 19 patients with renovascular hypertension the effect of a morning snack comprising meat (1 g protein per 1 kg body weight) on urinary albumin excretion was assessed. Concurrently the plasma creatinine concentration (Pcr) was examined which varied between normal and 260 mumol/l and the creatinine clearance (Ccr). After administration of an acute protein load the mean Ccr value increased by 23%. The albumin excretion, however, did not change substantially, as compared with the previous collection period (mean 17 and 18 micrograms/min). Microalbuminuria was recorded in 31% of the patients and its prevalence was directly related to the increasing Pcr value. The results revealed that an acute protein load did not increase albuminuria although the rise of Ccr was significant. The variability of albumin excretion in the course of the day is, however, influenced also by other factors and for assessment of microalbuminuria therefore examination of 24-hour urine samples should be preferred.

  20. Impact of microalbuminuria on incident coronary heart disease, cardiovascular and all-cause mortality: a meta-analysis of prospective studies.

    PubMed

    Xia, Fang; Liu, Guanghua; Shi, Yifu; Zhang, Yan

    2015-01-01

    This study is to investigate the magnitude of relationship between microalbuminuria and incident coronary heart disease (CHD) and mortality in the general population by conducting a meta-analysis. A comprehensive literature search in Pubmed and Embase database was performed prior to March 2014. Only prospective studies investigating the presence of microalbuminuria and incident CHD, cardiovascular disease (CVD), and mortality and were selected. Pooled risk ratio (RR) and 95% confidence interval (CI) were calculated by the presence of microalbuminuria versus without microalbuminuria. Finally, we identified 8 prospective studies involving 114,105 individuals. Participants with microalbuminuria were associated with 69% greater risk of CVD (RR=1.69; 95% CI 1.41-2.02) and 41% greater risk of CHD (RR=1.41; 95% CI 1.17-1.69). Participants with microalbuminuria were also associated with 57% greater risk of cardiovascular mortality (RR=1.57; 95% CI 1.20-2.06) and 65% greater risk of all-cause mortality (RR=1.65; 95% CI 1.45-1.88). Microalbuminuria is an independent predictor for CHD, CVD, and all-cause mortality in the general population. Early detection of microalbuminuria in the general population is likely to identify patients at increased risk of CVD and mortality.

  1. Retinopathy and the Risk of Cardiovascular Disease in Patients with Chronic Kidney Disease (From the Chronic Renal Insufficiency Cohort Study [CRIC])

    PubMed Central

    Grunwald, Juan E.; Pistilli, Maxwell; Ying, Gui-Shuang; Maguire, Maureen; Daniel, Ebenezer; Whittock-Martin, Revell; Parker-Ostroff, Candace; Mohler, Emile; Lo, Joan C.; Townsend, Raymond R.; Gadegbeku, Crystal Ann; Lash, James Phillip; Fink, Jeffrey Craig; Rahman, Mahboob; Feldman, Harold; Kusek, John W.; Xie, Dawei

    2015-01-01

    Patients with chronic kidney disease (CKD) experience other diseases such as cardiovascular disease (CVD) and retinopathy. The purpose of this study was to assess whether retinopathy predicts future CVD events in a subgroup of the participants of the Chronic Renal Insufficiency Cohort (CRIC) study. In this ancillary investigation, 2605 CRIC participants were invited to participate and non-mydriatic fundus photographs were obtained in 1936 subjects. Using standard protocols, presence and severity of retinopathy (diabetic, hypertensive or other) and vessel diameter caliber were assessed at a central photograph reading center by trained graders masked to study participant’s information. Patients with a self-reported history of cardiovascular disease were excluded. Incident CVD events were adjudicated using medical records. Kidney function measurements, traditional and non-traditional risk factors for CVD were obtained. Presence and severity of retinopathy were associated with increased risk of development of any CVD in this population of CKD patients, and these associations persisted after adjustment for traditional risk factors for CVD. We also found a direct relationship between increased venular diameter and risk of development of CVD; however, the relationship was not statistically significant after adjustment for traditional risk factors. In conclusion, presence of retinopathy was associated with future CVD events, suggesting that retinovascular pathology may be indicative of macrovascular disease even after adjustment for renal dysfunction and traditional CVD risk factors. Assessment of retinal morphology may be valuable in assessing risk of CVD in patients with CKD, both clinically and in research settings. PMID:26409637

  2. Brain MRI of children with retinopathy-negative cerebral malaria.

    PubMed

    Postels, Douglas G; Li, Chenxi; Birbeck, Gretchen L; Taylor, Terrie E; Seydel, Karl B; Kampondeni, Sam D; Glover, Simon J; Potchen, Michael J

    2014-11-01

    Our goals were to understand the brain magnetic resonance imaging (MRI) findings in children with retinopathy-negative cerebral malaria (CM) and investigate whether any findings on acute MRI were associated with adverse outcomes. We performed MRI scans on children admitted to the hospital in Blantyre, Malawi with clinically defined CM. Two hundred and seventeen children were imaged during the study period; 44 patients were malarial retinopathy-negative; and 173 patients were retinopathy-positive. We compared MRI findings in children with retinopathy-negative and retinopathy-positive CM. In children who were retinopathy-negative, we identified MRI variables that were associated with death and adverse neurologic outcomes. On multivariate analysis, cortical diffusion weighted imaging (DWI) abnormality and increased brain volume were strongly associated with neurologic morbidity in survivors. Investigations to explore the underlying pathophysiologic processes responsible for these MRI changes are warranted. © The American Society of Tropical Medicine and Hygiene.

  3. Operational Components of Telemedicine Programs for Diabetic Retinopathy.

    PubMed

    Horton, Mark B; Silva, Paolo S; Cavallerano, Jerry D; Aiello, Lloyd Paul

    2016-12-01

    Diabetic retinopathy is a leading cause of new-onset vision loss worldwide. Treatments supported by large clinical trials are effective in preserving vision, but many persons do not receive timely diagnosis and treatment of diabetic retinopathy, which is typically asymptomatic when most treatable. Telemedicine evaluation to identify diabetic retinopathy has the potential to improve access to care and improve outcomes, but incomplete implementation of published standards creates a risk to program utility and sustainability. In a prior article, we reviewed the literature regarding the impact of imaging device, number and size of retinal images, pupil dilation, type of image grader, and diagnostic accuracy on telemedicine assessment for diabetic retinopathy. This article reviews the literature regarding the impact of automated image grading, cost effectiveness, program standards, and quality assurance (QA) on telemedicine assessment of diabetic retinopathy. Telemedicine assessment of diabetic retinopathy has the potential to preserve vision, but greater attention to development and implementation of standards is needed to better realize its potential.

  4. Brain MRI of Children with Retinopathy-Negative Cerebral Malaria

    PubMed Central

    Postels, Douglas G.; Li, Chenxi; Birbeck, Gretchen L.; Taylor, Terrie E.; Seydel, Karl B.; Kampondeni, Sam D.; Glover, Simon J.; Potchen, Michael J.

    2014-01-01

    Our goals were to understand the brain magnetic resonance imaging (MRI) findings in children with retinopathy-negative cerebral malaria (CM) and investigate whether any findings on acute MRI were associated with adverse outcomes. We performed MRI scans on children admitted to the hospital in Blantyre, Malawi with clinically defined CM. Two hundred and seventeen children were imaged during the study period; 44 patients were malarial retinopathy-negative; and 173 patients were retinopathy-positive. We compared MRI findings in children with retinopathy-negative and retinopathy-positive CM. In children who were retinopathy-negative, we identified MRI variables that were associated with death and adverse neurologic outcomes. On multivariate analysis, cortical diffusion weighted imaging (DWI) abnormality and increased brain volume were strongly associated with neurologic morbidity in survivors. Investigations to explore the underlying pathophysiologic processes responsible for these MRI changes are warranted. PMID:25200262

  5. Novel Pharmacologic Approaches for the Management of Diabetic Retinopathy

    PubMed Central

    Kovach, Jaclyn L.; Schwartz, Stephen G.

    2010-01-01

    Diabetic retinopathy is the leading cause of vision loss among working-age people in the United States. The hallmark of diabetic retinopathy is vascular compromise. Increased vascular permeability leads to the development of diabetic macular edema, which is the major cause of vision loss in patients with diabetic retinopathy. Vascular occlusion causes retinal ischemia and subsequent angiogenesis (proliferative diabetic retinopathy), which increases the risk for vitreous hemorrhage and retinal detachment. Over the past 30 years our understanding of the pathophysiology of diabetic retinopathy has evolved greatly and has fostered the development of many novel treatments for this condition. This article will review promising new local and systemic pharmacologic treatments for diabetic macular edema and proliferative diabetic retinopathy. PMID:20352067

  6. [Control of blood pressure in hypertensive patients on combination therapy].

    PubMed

    de la Sierra, Alejandro; Oliveras, Anna; Armario, Pedro; Lucas, Silvia

    2015-02-20

    The impact of antihypertensive treatment on blood pressure (BP) control is fairly unknown. The aim of the study was to evaluate the degree of BP control and its relationship with treatment-related factors in hypertensive patients treated with 2 or 3 agents and attended in referral units. We studied 1,337 hypertensive subjects (41% women) with a mean age (SD) of 63 (12) years, who were receiving 2 or 3 antihypertensive drugs. The degree of BP control was estimated in a single visit by the proportion of patients with BP below 140/90mmHg. BP was controlled in 767 patients (57%). Lack of BP control was related to older age (12% risk for each 10-year increase) and the presence of microalbuminuria (64% risk increase). In those treated with 2 agents, BP control was 61%, without differences between those treated with fixed-drug or free combinations. BP control in those treated with 3 agents was 55%, higher in those receiving 3 agents in a fixed-drug combination (68%) compared with those on 3 agents administered separately (52%; P=.025). Drug classes used in combinations did not influence the degree of BP control. The degree of BP control in patients treated with 2 or 3 agents is 57%. Microalbuminuria is related to a lack of BP control. In those receiving 3 agents, the use of fixed-drug combinations is associated with better BP control. Copyright © 2013 Elsevier España, S.L.U. All rights reserved.

  7. Lipid transfer to HDL in type-2 diabetic patients: associations with microalbuminuria, statin, and insulin.

    PubMed

    Feitosa-Filho, Gilson Soares; Seydell, Talita de Mattos; Feitosa, Alina Coutinho Rodrigues; Maranhão, Raul Cavalcante; Ramires, José Antônio Franchini

    2009-02-01

    Type-2 diabetes mellitus (T2DM) is an isolated risk factor for coronary artery disease, especially when associated with microalbuminuria (MA). Structural and functional changes in lipoproteins have not yet been fully elucidated in this context. To assess lipid transfer (T) to HDL in type-2 diabetic patients and its association with microalbuminuria and treatment with statins or insulin. Thirty-three patients with type-2 diabetes mellitus and 34 age-matched control subjects were studied. A synthetic cholesterol-rich nanoemulsion radiolabeled with (3)H- triglycerides (TG) and 14C-free cholesterol (FC) or (3)H- cholesteryl ester (CE) and 14C-phospholipids (PL) was incubated with plasma. Both the nanoemulsion and lipoproteins were precipitated, except for HDL, which was counted for radioactivity. PLT (%) was higher in the T2DM group than in the control group (25.2 +/- 3.2 and 19.7 +/- 3.2 respectively; p < 0.001), as was free cholesterol (% FC): 9.1 +/- 2.7 and 6.3 +/- 1.5 respectively; p < 0.001. The diagnosis of microalbuminuria (MA) was not associated with changes in lipid transfers. Insulin therapy was associated with lower PLT rates: 23.5 +/- 2.1 versus 26.1 +/- 3.3; p = 0.018. Statin therapy, in turn, was associated with a drop in all lipid transfers - CET 3.5 +/- 0.9; PLT: 23.8 +/- 2.0; TGT: 3.9 +/- 0.8; FCT: 7.4 +/- 1.3 - as compared to the group that was not on statin therapy (CET: 5.9 +/- 2.4; PLT: 26.9 +/- 3.6; TGT: 6.4 +/- 2.2; FCT: 11.1 +/- 2.6). Type-2 diabetes mellitus increased lipid transfer to HDL particles, whereas statin therapy decreased all lipid transfers. The presence of MA was not associated with changes in lipid transfer.

  8. Impact of cystatin C and microalbuminuria on cognitive impairment in the population of community-dwelling Japanese.

    PubMed

    Kono, Shoko; Adachi, Hisashi; Enomoto, Mika; Fukami, Ako; Kumagai, Eita; Nakamura, Sachiko; Nohara, Yume; Morikawa, Nagisa; Nakao, Erika; Sakaue, Akiko; Tsuru, Tomoko; Fukumoto, Yoshihiro

    2017-10-01

    Cognitive impairment is an important element affecting our well-being, and as such, early diagnosis is critical today. We investigated whether serum cystatin C and microalbuminuria are associated with cognitive impairment. A total of 1943 subjects (774 males, 1169 females, mean age 65.8 years) took part in the investigation, and underwent a health examination in Tanushimaru, Japan, in 2009. The participants' cognitive function was evaluated using of mini-mental state examination (MMSE). We measured the levels of serum cystatin C using latex nephelometric immunoassay. Spot urine samples were used to measure microalbuminuria levels. Multivariate linear regression analyses were used to assess the relationship between MMSE scores and the level of cystatin C or microalbuminuria. All statistical analyses were performed using the SAS system. The mean values of log-transformed serum cystatin C levels and log-transformed microalbuminuria were 0.95 (range 0.41-7.11) mg/L and 10.7 (range 1.1-2600) mg/g·Cr, respectively. The means of MMSE score were 27.7 ± 2.5. In the multivariate linear regression analyses adjusted for age and sex, MMSE was significantly associated with systolic blood pressure (p = 0.024, inversely), cystatin C (p = 0.046, inversely) and microalbuminuria (p = 0.019, inversely), whereas estimated glomerular filtration rate (eGFR) had an insignificant association (p = 0.197). In the multiple stepwise linear regression analysis, age, history of stroke, systolic blood pressure, serum cystatin C were independently associated with MMSE levels. We demonstrated for the first time that cognitive function was significantly and inversely associated with cystatin C and microalbuminuria, in the relatively younger general population. Copyright © 2017 Elsevier B.V. All rights reserved.

  9. Retinopathy secondary to radiation therapy for squamous cell carcinoma

    SciTech Connect

    Groomer, A.E.; Gutwein, D.E. )

    1989-09-01

    This report discusses a case of radiotherapy-induced retinopathy following treatment of squamous cell carcinoma. Treatment of the carcinoma with external beam radiotherapy to the supraorbital region and base of the skull was followed by the onset of retinopathy. The sensory retina, as well as other central nervous system tissues, is highly resistant to radiation damage; however, the retinal vasculature is extremely sensitive to radiation damage, producing a retinopathy that is characteristic of other vascular occlusive diseases. Management is discussed.

  10. High-resolution adaptive optics findings in talc retinopathy.

    PubMed

    Soliman, Mohamed K; Sarwar, Salman; Hanout, Mostafa; Sadiq, Mohammad A; Agarwal, Aniruddha; Gulati, Vikas; Nguyen, Quan Dong; Sepah, Yasir J

    2015-01-01

    Talc retinopathy is a recognized ocular condition characterized by the presence of small, yellow, glistening crystals found inside small retinal vessels and within different retinal layers. These crystals can be associated with retinal vascular occlusion and ischemia. Different diagnostic modalities have been used previously to characterize the retinal lesions in talc retinopathy. Adaptive optics, a high resolution imaging technique, is used to evaluate the location, appearance and distribution of talc crystals in a case of talc retinopathy.

  11. Severe diabetic retinopathy at presentation in a young man.

    PubMed Central

    Morris, G. C.; James, R. A.; Powell, R. G.; Jones, M. K.

    1991-01-01

    A 22 year old man presented with a severe ischaemic diabetic retinopathy and, in spite of photocoagulation therapy, was blind in one eye 16 months after diagnosis. Four similar cases of aggressive diabetic retinopathy are reviewed. There is increasing evidence that a small group of young men with insulin dependent diabetes (IDD) may develop severe diabetic retinopathy at, or soon after, diagnosis. Images Figure 1 PMID:1904157

  12. Inflammatory, Hemostatic, and Other Novel Biomarkers for Diabetic Retinopathy

    PubMed Central

    Nguyen, Thanh T.; Alibrahim, Ekaterina; Islam, F.M. Amirul; Klein, Ronald; Klein, Barbara E.K.; Cotch, Mary Frances; Shea, Steven; Wong, Tien Y.

    2009-01-01

    OBJECTIVE There are conflicting data regarding relationships of systemic biomarkers of inflammation, hemostasis, and homocysteine with diabetic retinopathy. We examined these relationships in the Multi-Ethnic Study of Atherosclerosis. RESEARCH DESIGN AND METHODS A total of 921 participants with diabetes were included. Diabetic retinopathy was graded from retinal photographs. We defined two outcomes: any diabetic retinopathy and vision-threatening diabetic retinopathy (severe nonproliferative diabetic retinopathy or worse). Systemic markers analyzed were C-reactive protein, homocysteine, fibrinogen, plasmin-α2-antiplasmin complex (PAP), interleukin-6, d-dimer, factor VIII, serum creatinine, and urinary albumin-to-creatinine (UAC) ratio. RESULTS Prevalence of diabetic retinopathy was 33.2% and vision-threatening diabetic retinopathy 7.1%. After adjusting for established risk factors (diabetes duration, A1C, systolic blood pressure, waist-to-hip ratio, and use of diabetes medications), fibrinogen (odds ratio 1.14 [95% CI 1.01–1.32], P = 0.05) and PAP (1.25 [1.05–1.50], P = 0.01) were associated with any diabetic retinopathy, while PAP (1.54 [1.13–2.11], P = 0.007) and homocysteine (1.57 [1.16–2.11], P = 0.003) were associated with vision-threatening diabetic retinopathy. Only PAP remained significant after additional adjustment for serum creatinine and UAC ratio. Area under receiver-operator characteristic curve (AUROC) for diabetic retinopathy was constructed for established and novel risk factors. Established risk factors accounted for a 39.2% increase of the AUROC, whereas novel markers (fibrinogen, PAP, homocysteine, serum creatinine, and UAC ratio) only accounted for an additional 2.2%. CONCLUSIONS There were few associations of novel markers of inflammation, hemostasis, and homocysteine with diabetic retinopathy after controlling for established risk factors. These data suggest that there is limited clinical use of these biomarkers for prediction of

  13. Diabetic Nephropathy and Microalbuminuria in Pregnant Women With Type 1 and Type 2 Diabetes

    PubMed Central

    Damm, Julie Agner; Ásbjörnsdóttir, Björg; Callesen, Nicoline Foged; Mathiesen, Jonathan M.; Ringholm, Lene; Pedersen, Berit Woetmann; Mathiesen, Elisabeth R.

    2013-01-01

    OBJECTIVE To evaluate the prevalence of diabetic nephropathy and microalbuminuria in pregnant women with type 2 diabetes in comparison with type 1 diabetes and to describe pregnancy outcomes in these women following the same antihypertensive protocol. RESEARCH DESIGN AND METHODS Among 220 women with type 2 diabetes and 445 women with type 1 diabetes giving birth from 2007–2012, 41 women had diabetic nephropathy (albumin-creatinine ratio ≥300 mg/g) or microalbuminuria (albumin-creatinine ratio 30–299 mg/g) in early pregnancy. Antihypertensive therapy was initiated if blood pressure ≥135/85 mmHg or albumin-creatinine ratio ≥300 mg/g. RESULTS The prevalence of diabetic nephropathy was 2.3% (5 of 220) in women with type 2 diabetes and 2.5% (11 of 445) in women with type 1 diabetes (P = 1.00). The figures for microalbuminuria were 4.5 (10 of 220) vs. 3.4% (15 of 445) (P = 0.39). Baseline glycemic control was comparable between women with type 2 diabetes (n = 15) and type 1 diabetes (n = 26). Blood pressure at baseline was median 128 (range 100–164)/81 (68–91) vs. 132 (100–176)/80 (63–100) mmHg (not significant) and antihypertensive therapy in type 2 versus type 1 diabetes was used in 0 and 62%, respectively, at baseline, increasing to 33 and 96%, respectively, in late pregnancy. Pregnancy outcome was comparable regardless type of diabetes; gestational age at delivery: 259 days (221–276) vs. 257 (184–271) (P = 0.19); birth weight 3,304 g (1,278–3,914) vs. 2,850 (370–4,180) (P = 0.67). CONCLUSIONS The prevalence of diabetic nephropathy and microalbuminuria in early pregnancy was similar in type 2 and type 1 diabetes. Antihypertensive therapy was used more frequently in type 1 diabetes. Pregnancy outcome was comparable regardless type of diabetes. PMID:24009298

  14. Optical coherence tomography of chronic solar retinopathy.

    PubMed

    Garg, Sunir J; Martidis, Adam; Nelson, Mark L; Sivalingam, Arunan

    2004-02-01

    To describe the optical coherence tomographic findings in eight eyes of four patients with chronic solar retinopathy. All patients had a history of sun gazing months to years prior to presentation. Retrospective case series. Patients were examined using biomicroscopy performed by two or more experienced vitreoretinal specialists. All eight eyes had optical coherence tomography performed at the time of initial examination. All patients had a history of sun gazing and decreased vision in both eyes. On biomicroscopy, all eyes had a small, irregularly-shaped lamellar defect in the foveal center. No posterior vitreous detachment was present in any eye. Optical coherence tomography revealed a hyporeflective space at the level of the outer neurosensory retina and retinal pigment epithelium in all eyes. Optical coherence tomography demonstrates a characteristic hyporeflective space in the outer retina in patients with chronic solar retinopathy. These findings correlate with the histopathology of this condition and may be a useful clinical tool in confirming its diagnosis.

  15. Risk of microalbuminuria and progression to macroalbuminuria in a cohort with childhood onset type 1 diabetes: prospective observational study

    PubMed Central

    2008-01-01

    Objectives To describe independent predictors for the development of microalbuminuria and progression to macroalbuminuria in those with childhood onset type 1 diabetes. Design Prospective observational study with follow-up for 9.8 (SD 3.8) years. Setting Oxford regional prospective study. Participants 527 participants with a diagnosis of type 1 diabetes at mean age 8.8 (SD 4.0) years. Main outcome measures Annual measurement of glycated haemoglobin (HbA1c) and assessment of urinary albumin:creatinine ratio. Results Cumulative prevalence of microalbuminuria was 25.7% (95% confidence interval 21.3% to 30.1%) after 10 years of diabetes and 50.7% (40.5% to 60.9%) after 19 years of diabetes and 5182 patient years of follow-up. The only modifiable adjusted predictor for microalbuminuria was high HbA1c concentrations (hazard ratio per 1% rise in HbA1c 1.39, 1.27 to 1.52). Blood pressure and history of smoking were not predictors. Microalbuminuria was persistent in 48% of patients. Cumulative prevalence of progression from microalbuminuria to macroalbuminuria was 13.9% (12.9% to 14.9%); progression occurred at a mean age of 18.5 (5.8) years. Although the sample size was small, modifiable predictors of macroalbuminuria were higher HbA1c levels and both persistent and intermittent microalbuminuria (hazard ratios 1.42 (1.22 to 1.78), 27.72 (7.99 to 96.12), and 8.76 (2.44 to 31.44), respectively). Conclusion In childhood onset type 1 diabetes, the only modifiable predictors were poor glycaemic control for the development of microalbuminuria and poor control and microalbuminuria (both persistent and intermittent) for progression to macroalbuminuria. Risk for macroalbuminuria is similar to that observed in cohorts with adult onset disease but as it occurs in young adult life early intervention in normotensive adolescents might be needed to improve prognosis. PMID:18349042

  16. Argon laser photo-coagulation complications in diabetic retinopathy.

    PubMed

    Pavljasević, Suzana; Pranjić, Nurka; Sarajlić, Dzevdet

    2004-05-01

    Diabetic retinopathy is a disease based on vascular genesis that begins as microangiopathy and develops into macroangioapthy preceded by fibroproliferation changes. According to histo- pathological changes, diabetic retinopathy is divided into nonproliferative, pre-proliferative and proliferative diabetic retinopathy. Possibilities and needs for photo-coagulation in the earlier and later changes in retina reduce the meaning of conservative treatment. Laser photo-coagulation with therapeutical may cause unwanted and damaging effects, as well. Complications diagnosed in diabetic retinopathy, such as cataract, secondary glaucoma, central retinal vein thrombosis, haemophthalmus, are much more frequent in patients with laser photo-coagulation treatment.

  17. Neurodegeneration and neuroprotection in diabetic retinopathy.

    PubMed

    Ola, Mohammad Shamsul; Nawaz, Mohd Imtiaz; Khan, Haseeb A; Alhomida, Abdullah S

    2013-01-28

    Diabetic retinopathy is widely considered to be a neurovascular disease. This is in contrast to its previous identity as solely a vascular disease. Early in the disease progression of diabetes, the major cells in the neuronal component of the retina consist of retinal ganglion cells and glial cells, both of which have been found to be compromised. A number of retinal function tests also indicated a functional deficit in diabetic retina, which further supports dysfunction of neuronal cells. As an endocrinological disorder, diabetes alters metabolism both systemically and locally in several body organs, including the retina. A growing body of evidences indicates increased levels of excitotoxic metabolites, including glutamate, branched chain amino acids and homocysteine in cases of diabetic retinopathy. Also present, early in the disease, are decreased levels of folic acid and vitamin-B12, which are potential metabolites capable of damaging neurons. These altered levels of metabolites are found to activate several metabolic pathways, leading to increases in oxidative stress and decreases in the level of neurotrophic factors. As a consequence, they may damage retinal neurons in diabetic patients. In this review, we have discussed those potential excitotoxic metabolites and their implications in neuronal damage. Possible therapeutic targets to protect neurons are also discussed. However, further research is needed to understand the exact molecular mechanism of neurodegeneration so that effective neuroprotection strategies can be developed. By protecting retinal neurons early in diabetic retinopathy cases, damage of retinal vessels can be protected, thereby helping to ameliorate the progression of diabetic retinopathy, a leading cause of blindness worldwide.

  18. Autoimmune retinopathy: A case report from India

    PubMed Central

    Ganesh, Sudha K.; Ahmed, Arshee S.

    2017-01-01

    A first case report of autoimmune retinopathy (AIR) from India. A middle-aged female patient presented with subacute loss of vision in both eyes. Clinical examination revealed a near normal fundus in both the eyes. A presumed diagnosis of nonparaneoplastic AIR was made based on clinical features and suggestive investigations. Early detection and management with steroids or immunosuppression may be beneficial to patients with AIR. PMID:28298865

  19. [Optical coherence tomography in solar eclipse retinopathy].

    PubMed

    Calvo-González, C; Reche-Frutos, J; Santos-Bueso, E; Díaz-Valle, D; Benítez-del-Castillo, J M; García-Sánchez, J

    2006-05-01

    We describe the case of a patient suffering from acute visual loss soon after watching a solar eclipse. Optical coherence tomography was the main diagnostic tool used. Solar retinopathy is now an unusual cause of visual loss, although there are still some cases diagnosed, especially after viewing solar eclipses. Optical coherence tomography is suitable for detecting permanent retinal injuries related to solar exposure, with the outer retinal layers being typically affected.

  20. Müller cells and diabetic retinopathy.

    PubMed

    Coughlin, Brandon A; Feenstra, Derrick J; Mohr, Susanne

    2017-09-05

    Müller cells are one of the primary glial cell types found in the retina and play a significant role in maintaining retinal function and health. Since Müller cells are the only cell type to span the entire width of the retina and have contact to almost every cell type in the retina they are uniquely positioned to perform a wide variety of functions necessary to maintaining retinal homeostasis. In the healthy retina, Müller cells recycle neurotransmitters, prevent glutamate toxicity, redistribute ions by spatial buffering, participate in the retinoid cycle, and regulate nutrient supplies by multiple mechanisms. Any disturbance to the retinal environment is going to influence proper Müller cell function and well being which in turn will affect the entire retina. This is evident in a disease like diabetic retinopathy where Müller cells contribute to neuronal dysfunction, the production of pro-angiogenic factors leading to neovascularization, the set up of a chronic inflammatory retinal environment, and eventual cell death. In this review, we highlight the importance of Müller cells in maintaining a healthy and functioning retina and discuss various pathological events of diabetic retinopathy in which Müller cells seem to play a crucial role. The beneficial and detrimental effects of cytokine and growth factor production by Müller cells on the microvasculature and retinal neuronal tissue will be outlined. Understanding Müller cell functions within the retina and restoring such function in diabetic retinopathy should become a cornerstone for developing effective therapies to treat diabetic retinopathy. Copyright © 2017 Elsevier Ltd. All rights reserved.

  1. The Impact of Blood Pressure Variability on Subclinical Ventricular, Renal and Vascular Dysfunction, in Patients with Hypertension and Diabetes

    PubMed Central

    CIOBANU, Andrea O; GHERGHINESCU, Carmen Lucia; DULGHERU, Raluca; MAGDA, Stefania; DRAGOI GALRINHO, Ruxandra; FLORESCU, Maria; GUBERNA, Suzana; CINTEZA, Mircea; VINEREANU, Dragos

    2013-01-01

    ABSTRACT Background: Blood pressure variability (BPV) was proved as a cardiovascular risk factor. One of its mechanisms is related to arterial stiffness and ventriculo-arterial coupling; however its impact on subclinical cardiovascular dysfunction has not been evaluated yet. Objectives: To assess the relationship between BPV on 24 hours, and subclinical left ventricle (LV), renal, and vascular dysfunction in diabetic and hypertensive patients. Material and methods: We studied 56 patients (57±9 years, 29 men) with mild-to-moderate hypertension and type 2 diabetes, no cardiovascular disease, normal ejection fraction and normal renal function. 24 hours ambulatory blood pressure monitoring (ABPM) was used to assess BPV, daytime (d) and night time (n), by: 1. mean (M); 2. standard deviation of mean (SD); 3. variance (Vr); 4. coefficient of variation (CV); 5. day/night variation: reverse dippers, non-dippers, dippers and extreme dippers; conventional and 2D speckle tracking echo to assess LV function; myocardial deformation was measured as global longitudinal strain (GLS). Endothelial (flow mediated dilation, FMD) and arterial function (intima media-thickness, IMT; pulse wave velocity, PWV), microalbuminuria were tested. Outcomes: Daytime BPV correlates inversely with subclinical myocardial function evaluated through GLS. Daytime systolic BPV correlates positively with IMT (all rho > 0.30, all p < 0.05). Also, there is a significantly inverse correlation between mean BP and GLS. We found a direct correlation between mean BP, but not BPV, and microalbuminuria (all rho > - 0.30 and all p < 0.05). We found no correlation between BPV and FMD, PWV. There were no differences for GLS, microalbuminuria and FMD between dipper groups. Conclusions: In diabetic patients with mild-to-moderate hypertension, increased daytime blood pressure variability correlates with subclinical left ventricular dysfunction and arterial function (IMT), while microalbuminuria correlates with elevated

  2. Hemorrhagic Retinopathy Following Spondylosis Surgery and Seizure

    PubMed Central

    Valeshabad, Ali Kord; Francis, Andrew W.; Setlur, Vikram; Chang, Peter; Mieler, William F.; Shahidi, Mahnaz

    2015-01-01

    Purpose To report bilateral hemorrhagic retinopathy in an adult female following lumbar spinal surgery and seizure. Case Report A 38 year old female presented with bilateral blurry vision and spots in the visual field. The patient had lumbar spondylosis surgery which was complicated by a dural tear with persistent cerebrospinal fluid leak. Visual symptoms started immediately following witnessed seizure-like activity. At presentation, visual acuity was 20/100 and 20/25 in the right and left eye, respectively. Dilated fundus examination demonstrated bilateral hemorrhagic retinopathy with subhyaloid, intraretinal and subretinal involvement. At 4 month follow up, visual acuity improved to 20/60 and 20/20 in the right and left eye, respectively. Dilated fundus examination and fundus photography showed resolution of retinal hemorrhages in both eyes. Conclusions The first case of bilateral hemorrhagic retinopathy following lumbar spondylosis surgery and witnessed seizure in an adult was reported. Ophthalmic examination may be warranted following episodes of seizure in adults. PMID:26099062

  3. Correlation of ultrasonographic measurement of intrarenal arterial resistance index with microalbuminuria in nonhypertensive, nondiabetic obese patients.

    PubMed

    Han, Fang; Hou, Ningning; Miao, Wei; Sun, Xiaodong

    2013-08-01

    To determine whether intrarenal arterial resistance index (RI) value is related to increased urinary albumin excretion and whether RI value is an independent good indicator to evaluate early renal damage in nonhypertensive, nondiabetic obese subjects. Sixty-four nonhypertensive, nondiabetic obese patients (OB) and 35 age- and sex-matched normal healthy subjects were involved in this study. Clinical characteristics and blood biochemistry of all the subjects were measured. Urinary albumin/creatinine ratio (ACR) and sonographic evaluation of renal blood flow were determined. ACR and interlobar arterial RI were significantly higher in obese patients than those of normal healthy subjects. Interlobar arterial RI value was higher in patients with microalbuminuria than those with normoalbuminuria. Correlation analysis showed interlobar artery RI value had a positive correlation with ACR (r = 0.615, p < 0.01) and plasma free fatty acids (FFAs, r = 0.407, p < 0.01). ACR had a positive correlation with BMI (r = 0.380, p < 0.01), waist circumference (r = 0.414, p < 0.01), plasma FFAs (r = 0.537, p < 0.01). Multivariate regression analyses showed that ACR was best predicted by interlobar artery RI value even when body mass index, waist circumference, FFAs, and high-sensitive C reaction protein were added in the statistical analysis. Interlobar arterial RI may be an independent predictor of microalbuminuria in nonhypertensive, nondiabetic obese patients, and interlobar arterial RI could be a useful tool for assessment early renal damage in obese patients.

  4. Mineralocorticoid hypertension

    PubMed Central

    Gupta, Vishal

    2011-01-01

    Hypertension affects about 10 – 25% of the population and is an important risk factor for cardiovascular and renal disease. The renin-angiotensin system is frequently implicated in the pathophysiology of hypertension, be it primary or secondary. The prevalence of primary aldosteronism increases with the severity of hypertension, from 2% in patients with grade 1 hypertension to 20% among resistant hypertensives. Mineralcorticoid hypertension includes a spectrum of disorders ranging from renin-producing pathologies (renin-secreting tumors, malignant hypertension, coarctation of aorta), aldosterone-producing pathologies (primary aldosteronism – Conns syndrome, familial hyperaldosteronism 1, 2, and 3), non-aldosterone mineralocorticoid producing pathologies (apparent mineralocorticoid excess syndrome, Liddle syndrome, deoxycorticosterone-secreting tumors, ectopic adrenocorticotropic hormones (ACTH) syndrome, congenitalvadrenal hyperplasia), and drugs with mineraocorticoid activity (locorice, carbenoxole therapy) to glucocorticoid receptor resistance syndromes. Clinical presentation includes hypertension with varying severity, hypokalemia, and alkalosis. Ratio of plasma aldosterone concentraion to plasma renin activity remains the best screening tool. Bilateral adrenal venous sampling is the best diagnostic test coupled with a CT scan. Treatment is either surgical (adrenelectomy) for unilateral adrenal disease versus medical therapy for idiopathic, ambiguous, or bilateral disease. Medical therapy focuses on blood pressure control and correction of hypokalemia using a combination of anti-hypertensives (calcium channel blockers, angiotensin converting enzyme inhibitors, or angiotensin receptor blockers) and potassium-raising therapies (mineralcorticoid receptor antagonist or potassium sparing diuretics). Direct aldosterone synthetase antagonists represent a promising future therapy. PMID:22145132

  5. [Role of ophthalmoscopy in arterial hypertension: a problem revisited].

    PubMed

    Palatini, P; Penzo, M; Bongiovì, S; Canali, C; Pessina, A C

    1991-09-01

    To evaluate the present role of fundal examination in the assessment of the hypertensive patient, 348 hypertensive subjects, mostly with borderline or mild hypertension, were studied with direct ophthalmoscopy. The exam was always performed by the same observer. The degree of left ventricular hypertrophy was also evaluated with ECG and echocardiography. Blood pressure was measured with 24-hour ambulatory monitoring, using either the Del Mar Avionics Pressurometer II and IV, the Spacelabs 5200 or the A & D TM-2420. Signs of hypertensive retinopathy were found in 51% of the subjects. The degree of retinopathy, defined according to a modified Keith-Wagener grading system, was highly correlated with average 24-hour mean blood pressure (r = 0.31; p less than 0.0001). Based on ECG, 16% of the subjects had left ventricular hypertrophy, while 23% showed an echocardiographic left ventricular mass, indexed by body surface area, above the normal limits. Left ventricular mass index was correlated with ambulatory blood pressure levels, but at a lower level of statistical significance (r = 0.19; p less than 0.001) compared to the degree of retinopathy. No correlation was found between 24-hour blood pressure and ECG findings. Ophthalmoscopy proved to be more sensitive than echocardiography and ECG in indexing 24-hour blood pressure load, while the specificity of the 3 exams was similar. The present data indicate that fundal examination is a sensitive indicator of the vascular consequences of increased blood pressure and is therefore useful in the assessment of the hypertensive patient, while the more expensive echocardiography is not of great clinical value in borderline and mild hypertension.

  6. Unusual retinopathy in a child with severe combined immune deficiency.

    PubMed

    Gerth-Kahlert, Christina; Tiwari, Amit; Hauri-Hohl, Mathias M; Hanson, James V M; Bahr, Angela; Palmowski-Wolfe, Anja; Güngör, Tayfun; Berger, Wolfgang

    2017-08-16

    We describe a case of an infant diagnosed with severe combined immune deficiency (Adenosine Deaminase (ADA), SCID) with severe retinopathy and associated low vision in both eyes at first examination. An extensive infectious work up revealed an enterovirus infection, which suggested an early infectious and severe retinopathy. Genetic causes of congenital retinitis pigmentosa/ Leber's congenital amaurosis could be excluded by whole exome sequencing.

  7. Rheumatoid arthritis and the prevalence of diabetic retinopathy

    PubMed Central

    Wong, Joanna C.; Johnson, Sophia L.; Thorpe, Carolyn T.; Barney, Neal P.; Sheibani, Nader; Smith, Maureen A.

    2015-01-01

    Objective. RA increases vascular disease and angiogenesis, yet a 1964 Lancet report paradoxically linked RA to lower diabetic retinopathy. Our objective was to examine RA as a risk factor for diabetic retinopathy compared with other vascular risk factors. Methods. This cohort study compared the prevalence of diabetic retinopathy in diabetes patients with and without RA in a 5% Medicare sample. We analysed the impact of RA on the prevalence of diabetic retinopathy using multivariate logistic regression calculating adjusted rate ratios (ARRs) controlling for sociodemographics, co-morbidity and health utilization. Sensitivity analysis examined eye exam rates. Results. Among 256 331 Medicare diabetes patients, 5572 (2%) had RA. Diabetic retinopathy was less prevalent in patients with RA compared with those without RA (13.7% vs 16.1%, P ≤ 0.01). Compared with patients without RA, the adjusted model demonstrated that patients with diabetes and RA were 28% less likely to have diabetic retinopathy and 4% more likely to receive an eye exam [ARR 0.72 (95% CI 0.67, 0.77), ARR 1.04 (95% CI 1.02, 1.06)]. Conclusion. Findings support the 1964 paradox observing decreased diabetic retinopathy in patients with RA. These findings pose new questions regarding whether RA physiology or treatments protect against diabetic retinopathy and how intraocular factors vary in contrast to adverse vascular changes elsewhere. PMID:25731768

  8. Successful treatment of cancer-associated retinopathy with alemtuzumab.

    PubMed

    Espandar, Ladan; O'Brien, Susan; Thirkill, Charles; Lubecki, Linda A; Esmaeli, Bita

    2007-07-01

    We herein report a patient with cancer-associated retinopathy who experienced multiple bouts of paraneoplastic retinopathy and optic neuropathy but responded to treatments with alemtuzumab and was able to maintain useful vision over the course of 8 years of follow-up.

  9. Retinopathy of prematurity: An update on screening and management

    PubMed Central

    Jefferies, Ann L

    2016-01-01

    Retinopathy of prematurity is a proliferative disorder of the developing retinal blood vessels in preterm infants. The present practice point reviews new information regarding screening and management for retinopathy of prematurity, including the role of risk factors in screening, optimal scheduling for screening examinations, pain management, digital retinal photography and antivascular endothelial growth factor therapy. PMID:27095887

  10. Diagnosis, Epidemiology, and Management of Hypertension in Children.

    PubMed

    Rao, Goutham

    2016-08-01

    National guidelines for the diagnosis and management of hypertension in children have been available for nearly 40 years. Unfortunately, knowledge and recognition of the problem by clinicians remain poor. Prevalence estimates are highly variable because of differing standards, populations, and blood pressure (BP) measurement techniques. Estimates in the United States range from 0.3% to 4.5%. Risk factors for primary hypertension include overweight and obesity, male sex, older age, high sodium intake, and African American or Latino ancestry. Data relating hypertension in childhood to later cardiovascular events is currently lacking. It is known that BP in childhood is highly predictive of BP in adulthood. Compelling data about target organ damage is available, including the association of hypertension with left ventricular hypertrophy, carotid-intima media thickness, and microalbuminuria. Guidelines from both the United States and Europe include detailed recommendations for diagnosis and management. Diagnostic standards are based on clinic readings, ambulatory BP monitoring is useful in confirming diagnosis of hypertension and identifying white-coat hypertension, masked hypertension, and secondary hypertension, as well as monitoring response to therapy. Research priorities include the need for reliable prevalence estimates based on diverse populations and data about the long-term impact of childhood hypertension on cardiovascular morbidity and mortality. Priorities to improve clinical practice include more education among clinicians about diagnosis and management, clinical decision support to aid in diagnosis, and routine use of ambulatory BP monitoring to aid in diagnosis and to monitor response to treatment. Copyright © 2016 by the American Academy of Pediatrics.

  11. Anthocyanins as a potential therapy for diabetic retinopathy.

    PubMed

    Nabavi, S F; Habtemariam, S; Daglia, M; Shafighi, N; Barber, A J; Nabavi, S M

    2015-01-01

    Diabetic retinopathy is one of the most common complications of diabetes. A plethora of literature indicates that oxidative stress may play a central role in the pathogenesis of diabetic retinopathy. One could thus hypothesise that antioxidant therapies may be protective for diabetic retinopathy. Anthocyanins are important natural bioactive pigments responsible for red-blue colour of fruits, leaves, seeds, stems and flowers in a variety of plant species. Apart from their colours, anthocyanins are known to be health-promoting phytochemicals with potential properties useful to protect against oxidative stress in some degenerative diseases. They also have a variety of biological properties including anti-inflammatory, antibacterial, anticancer, and cardio-protective properties. Some reports further suggest a therapeutic role of anthocyanins to prevent and/or protect against ocular diseases but more studies are needed to examine their potential as alternative therapy to diabetic retinopathy. The present article reviews the available literature concerning the beneficial role of anthocyanins in diabetic retinopathy.

  12. Clinical Components of Telemedicine Programs for Diabetic Retinopathy.

    PubMed

    Horton, Mark B; Silva, Paolo S; Cavallerano, Jerry D; Aiello, Lloyd Paul

    2016-12-01

    Diabetic retinopathy is a leading cause of new-onset vision loss worldwide. Treatments supported by large clinical trials are effective in preserving vision, but many persons do not receive timely diagnosis and treatment of diabetic retinopathy, which is typically asymptomatic when most treatable. Telemedicine evaluation to identify diabetic retinopathy has the potential to improve access to care, but there are no universal standards regarding camera choice or protocol for ocular telemedicine. We review the literature regarding the impact of imaging device, number and size of retinal images, pupil dilation, type of image grader, and diagnostic accuracy on telemedicine assessment for diabetic retinopathy. Telemedicine assessment of diabetic retinopathy has the potential to preserve vision, but further development of telemedicine specific technology and standardization of operations are needed to better realize its potential.

  13. A Review on Recent Developments for Detection of Diabetic Retinopathy

    PubMed Central

    2016-01-01

    Diabetic retinopathy is caused by the retinal micro vasculature which may be formed as a result of diabetes mellitus. Blindness may appear as a result of unchecked and severe cases of diabetic retinopathy. Manual inspection of fundus images to check morphological changes in microaneurysms, exudates, blood vessels, hemorrhages, and macula is a very time-consuming and tedious work. It can be made easily with the help of computer-aided system and intervariability for the observer. In this paper, several techniques for detecting microaneurysms, hemorrhages, and exudates are discussed for ultimate detection of nonproliferative diabetic retinopathy. Blood vessels detection techniques are also discussed for the diagnosis of proliferative diabetic retinopathy. Furthermore, the paper elaborates a discussion on the experiments accessed by authors for the detection of diabetic retinopathy. This work will be helpful for the researchers and technical persons who want to utilize the ongoing research in this area. PMID:27777811

  14. Solar retinopathy and associated optical coherence tomography findings.

    PubMed

    Chen, Jennifer C; Lee, Lawrence R

    2004-11-01

    Solar retinopathy is a rare but well-recognised clinical entity of macular damage, caused by viewing a solar eclipse or direct sun-gazing. Visual deterioration from solar retinopathy typically ranges from 6/9 to 6/60 and in most cases the visual loss is reversible. We present a case of solar retinopathy following direct sun-gazing and illustrate the damage within the retinal structure with optical coherence tomographic (OCT) findings. The visual prognosis of solar retinopathy is usually favourable but prevention remains the mainstay of treatment. The optometrist may play an important role in patient education and reassurance, as well as differentiating solar retinopathy from other likely macular abnormalities.

  15. Effect of lisinopril on progression of retinopathy in normotensive people with type 1 diabetes. The EUCLID Study Group. EURODIAB Controlled Trial of Lisinopril in Insulin-Dependent Diabetes Mellitus.

    PubMed

    Chaturvedi, N; Sjolie, A K; Stephenson, J M; Abrahamian, H; Keipes, M; Castellarin, A; Rogulja-Pepeonik, Z; Fuller, J H

    1998-01-03

    Retinopathy commonly occurs in people with type 1 diabetes. Strict glycaemic control can decrease development and progression of retinopathy only partially. Blood pressure is also a risk factor for microvascular complications. Antihypertensive therapy, especially with inhibitors of angiotensin-converting enzyme (ACE), can slow progression of nephropathy, but the effects on retinopathy have not been established. We investigated the effect of lisinopril on retinopathy in type 1 diabetes. As part of a 2-year randomised double-blind placebo-controlled trial, we took retinal photographs at baseline and follow-up (24 months) in patients aged 20-59 in 15 European centres. Patients were not hypertensive, and were normoalbuminuric (85%) or microalbuminuric. Retinopathy was classified from photographs on a five-level scale (none to proliferative). The proportion of patients with retinopathy at baseline was 65% (117) in the placebo group and 59% (103) in the lisinopril group (p = 0.2). Patients on lisinopril had significantly lower HbA1c at baseline than those on placebo (6.9% vs 7.3 p = 0.05). Retinopathy progressed by at least one level in 21 (13.2%) of 159 patients on lisinopril and 39 (23.4%) of 166 patients on placebo (odds ratio 0.50 [95% CI 0.28-0.89], p = 0.02). This 50% reduction was the same when adjusted for centre and glycaemic control (0.55 [0.30-1.03], p = 0.06). Lisinopril also decreased progression by two or more grades (0.27 [0.07-1.00], p = 0.05), and progression to proliferative retinopathy (0.18 [0.04-0.82], p = 0.03). Progression was not associated with albuminuric status at baseline. Treatment reduced retinopathy incidence (0.69 [0.30-1.59], p = 0.4). Lisinopril may decrease retinopathy progression in non-hypertensive patients who have type 1 diabetes with little or no nephropathy. These findings need to be confirmed before changes to clinical practice can be advocated.

  16. Maternal diabetes programs hypertension and kidney injury in offspring.

    PubMed

    Chen, Yun-Wen; Chenier, Isabelle; Tran, Stella; Scotcher, Michael; Chang, Shiao-Ying; Zhang, Shao-Ling

    2010-07-01

    We investigated whether maternal diabetes programs the offspring to develop hypertension and kidney injury in adulthood and examined potential underlying mechanisms. In a murine model we studied the offspring of three groups of dams (non-diabetic, diabetic, and diabetic treated with insulin). Mean systolic blood pressure in the offspring was monitored from 8 to 20 weeks. Body and kidney weights in the offspring of diabetic mothers were significantly lower than in offspring of non-diabetic mothers. Offspring of diabetic mothers developed hypertension, microalbuminuria, and glucose intolerance. Increased accumulation of extracellular matrix proteins in the glomeruli and marked upregulation of angiotensinogen, angiotensin II type 1 receptor, angiotensin-converting enzyme, transforming growth factor beta-1 (TGF-beta1), and plasminogen activator inhibitor-1 (PAI-1) gene expression were evident in the renal cortex of hypertensive offspring of diabetic mothers. By contrast, angiotensin-converting enzyme-2 (ACE2) gene expression was lower in the hypertensive offspring of diabetic mothers than in that of non-diabetic mothers. These changes were prevented in the offspring of insulin-treated diabetic mothers. These data indicate that maternal diabetes induces perinatal programming of hypertension, renal injury, and glucose intolerance in the offspring and suggest a central role for the activation of the intrarenal renin-angiotensin system and TGF-beta1 gene expression in this process.

  17. Growth Factors in Proliferative Diabetic Retinopathy

    PubMed Central

    Khan, Zia Ali

    2003-01-01

    Many growth factors are implicated in the pathogenesis of proliferative diabetic retinopathy. Alteration of growth factors and their receptors in diabetes has been shown in both experimental and clinical studies. Sustained hyperglycemia resulting from long-standing diabetes leads to several biochemical abnormalities that consequently result in retinal hypoxia. Retinal oxygenation state regulates various growth factors that promote angiogenesis in order to meet the oxygen demands of the tissue. However, unregulated expression of these growth factors and induction of complex cascades leading to augmentation of other proangiogenic factors, which may not be regulated by tissue oxygenation, leads to uncontrolled retinal neovascularization and blindness in diabetic patients. PMID:14668050

  18. Optical coherence tomography in late solar retinopathy.

    PubMed

    Janković, Aleksandar; Vukosavljević, Miroslav; Avramović, Sinisa; Draganić, Biljana

    2011-08-01

    Solar retinopathy refers to retinal injury induced by direct or indirect solar viewing. We presented a patient who had observed partial solar eclipse 51 year before. He had bilaterally decreased vision and scar of the macular region at the time of presentation. The basic diagnostic tool applied in the presented patient, optical coherence tomography, showed hyporeflexivity of the outer retina in the segment of retinal pigment epithelial-photoreceptors complex with atrophy and thinning of the foveolar region. Optical coherence tomography is a powerful, non-invasive diagnostic tool which can ease the diagnosis and estimate the level and nature of the macular region damage.

  19. Ultra widefield fundus imaging for diabetic retinopathy.

    PubMed

    Kiss, Szilárd; Berenberg, Thomas L

    2014-08-01

    For decades, the standard method for screening and grading severity of diabetic retinal disease has relied upon a montage of photographs using normal angle fundus cameras. With the development of ultrawide field (UWF) fundus imaging, more of the retina can be imaged with fewer pictures, less dependence on photographer skill, and, often, greater ease on the patient. Recent studies have shown comparability between traditional and UWF imaging for standard grading of diabetic retinopathy. Moreover, UWF images can detect peripheral pathology not typically seen in standard photographs, which may enlighten our understanding of disease severity and suggest new indications for treatment.

  20. Portal hypertension.

    PubMed

    Garcia-Tsao, G

    2001-05-01

    Portal hypertension is the main complication of cirrhosis and is responsible for its most common complications: variceal hemorrhage, ascites, and portosystemic encephalopathy. Portal hypertension is the result of increased intrahepatic resistance and increased portal venous inflow, which in turn is the result of splanchnic vasodilatation. Vasodilatation (splanchnic and systemic) and hyperdynamic circulation are hemodynamic abnormalities typical of cirrhosis and portal hypertension. Gastroesophageal varices result almost solely from portal hypertension, although the hyperdynamic circulation contributes to variceal growth and hemorrhage. Ascites results from sinusoidal hypertension and sodium retention, which is, in turn, secondary to vasodilatation and activation of neurohumoral systems. The hepatorenal syndrome represents the result of extreme vasodilatation with an extreme decrease in effective blood volume that leads to maximal activation of vasoconstrictive systems, renal vasoconstriction, and renal failure. Spontaneous bacterial peritonitis is a potentially lethal infection of ascites that occurs in the absence of a local source of infection. Portosystemic encephalopathy is a consequence of both portal hypertension (shunting of blood through portosystemic collaterals) and hepatic insufficiency that result in the accumulation of neurotoxins in the brain. This paper reviews the recent advances in the pathophysiology and management of the complications of portal hypertension.

  1. Portal hypertension.

    PubMed

    Garcia-Tsao, Guadalupe

    2003-05-01

    Portal hypertension, the main complication of cirrhosis, is responsible for its most common complications: variceal hemorrhage, ascites, and portosystemic encephalopathy. Portal hypertension is the result of increased intrahepatic resistance and increased portal venous inflow. Vasodilatation (splanchnic and systemic) and the hyperdynamic circulation are hemodynamic abnormalities typical of cirrhosis and portal hypertension. Gastroesophageal varices result almost solely from portal hypertension, although the hyperdynamic circulation contributes to variceal growth and hemorrhage. Ascites results from sinusoidal hypertension and sodium retention, which, in turn, is secondary to vasodilatation and activation of neurohumoral systems. The hepatorenal syndrome represents the result of extreme vasodilatation, with an extreme decrease in effective blood volume that leads to maximal activation of vasoconstrictive systems, renal vasoconstriction, and renal failure. Spontaneous bacterial peritonitis is a potentially lethal infection of ascites that occurs in the absence of a local source of infection. Portosystemic encephalopathy is a consequence of both portal hypertension (shunting of blood through portosystemic collaterals) and hepatic insufficiency that result in the accumulation of neurotoxins in the brain. This review covers the recent advances in the pathophysiology and management of the complications of portal hypertension.

  2. Microalbuminuria--a marker of the risk of developing nephropathy in insulin-dependent diabetes.

    PubMed

    Dryáková, M; Englis, M; Bartos, V; Rozprimová, L; Sidlová, A; Malý, J

    1989-01-01

    The authors present partial results of a prospective study conducted in 65 insulin-dependent diabetics with varying duration of disease in whom development of micro-angiopathic organ alterations is followed in relation to diabetes compensation and development of clinically manifest proteinuria or to albumin excretion (microalbuminuria). The results suggest that the increase in albumin excretion in recent-onset and non-recent-onset patients is in most cases only an expression of changes in renal function due to metabolism and therapy and apparently of little value in predicting the risk of developing diabetic nephropathy. The situation is not so unambiguous in patients with long duration of diabetes and, in case increased albumin excretion remains unchanged or further increases despite intensive insulin therapy, it may serve most likely as a marker of high risk of developing diabetic nephropathy.

  3. [Microalbuminuria--a risk indicator for the development of nephropathy in insulin-dependent diabetics].

    PubMed

    Dryáková, M; Englis, M; Bartos, V; Rozprimová, L; Sidlová, A; Malý, J

    1989-10-27

    The authors submit preliminary results of a prospective study in 65 insulin-dependent diabetics with a varying duration of the disease where they followed up the development of microangiopathic organ changes in relation to the compensation of diabetes and the development of clinically manifest proteinuria or albumin excretion (microalbuminuria). From the results ensues that in recent and postrecent patients the increased albumin excretion is as a rule only a manifestation of metabolically conditioned and treatable changes of renal function and is of minor importance for the prediction of the risk of development of diabetic nephropathy. In patients with prolonged duration of diabetes the position is not unequivocal and if the albumin excretion persists or increases despite intensive insulin treatment it is most probably an indicator of a high risk of development of diabetic nephropathy.

  4. The prevalence of microalbuminuria and proteinuria in cats with diabetes mellitus.

    PubMed

    Al-Ghazlat, Suliman A; Langston, Cathy E; Greco, Deborah S; Reine, Nyssa J; May, Suzanne N; Shofer, Frances S

    2011-08-01

    The prevalence of microalbuminuria (MA) and proteinuria was evaluated in 66 cats with diabetes mellitus (DM), 35 nondiabetic cats with other illness, and 11 healthy nondiabetic cats with use of the E.R.D.-HealthScreen Feline Urine Test. The MA prevalence was higher in the diabetic than in the nondiabetic sick and healthy control cats (70%, 39%, and 18% respectively, P < .0001). In addition, prevalence of proteinuria defined by a protein/creatinine ratio (UPC) > 0.4 was significantly higher in the diabetic cat than in the control cats (70%, 35%, and 9% respectively, P < .0001). There was a significant but weak correlation between the results of MA and UPC (P < .0001, r = 0.43). Our results showed that MA is common in cats with DM. Further studies are required to evaluate the prognostic value of the presence and the severity of MA in cats with DM. Copyright © 2011 Elsevier Inc. All rights reserved.

  5. Medication adherence and quality of life among the elderly with diabetic retinopathy 1

    PubMed Central

    Jannuzzi, Fernanda Freire; Cintra, Fernanda Aparecida; Rodrigues, Roberta Cunha Matheus; São-João, Thaís Moreira; Gallani, Maria Cecília Bueno Jayme

    2014-01-01

    OBJECTIVE: to investigate the factors related to medication adherence and its relation to Health- Related Quality of Life (HRQoL) in elderly people with diabetic retinopathy. METHOD: one hundred (n=100) elderly outpatients with diabetic retinopathy taking antihypertensives and/or oral antidiabetics/insulin were interviewed. Adherence was evaluated by the adherence proportion and its association with the care taken in administrating medications and by the Morisky Scale. The National Eye Institute Visual Functioning Questionnaire (NEI VFQ-25) was used to evaluate HRQoL. RESULTS: most (58%) reported the use of 80% or more of the prescribed dose and care in utilizing the medication. The item "stopping the drug when experiencing an adverse event", from the Morisky Scale, explained 12.8% and 13.5% of the variability of adherence proportion to antihypertensives and oral antidiabetics/insulin, respectively. CONCLUSION: there was better HRQoL in the Color Vision, Driving and Social Functioning domains of the NEI VFQ-25. Individuals with lower scores on the NEI VFQ-25 and higher scores on the Morisky Scale presented greater chance to be nonadherent to the pharmacological treatment of diabetes and hypertension. PMID:25591084

  6. Diabetic retinopathy and diabetic macular edema: pathophysiology, screening, and novel therapies.

    PubMed

    Ciulla, Thomas A; Amador, Armando G; Zinman, Bernard

    2003-09-01

    Diabetic retinopathy (DR) and diabetic macular edema (DME) are leading causes of blindness in the working-age population of most developed countries. The increasing number of individuals with diabetes worldwide suggests that DR and DME will continue to be major contributors to vision loss and associated functional impairment for years to come. Early detection of retinopathy in individuals with diabetes is critical in preventing visual loss, but current methods of screening fail to identify a sizable number of high-risk patients. The control of diabetes-associated metabolic abnormalities (i.e., hyperglycemia, hyperlipidemia, and hypertension) is also important in preserving visual function because these conditions have been identified as risk factors for both the development and progression of DR/DME. The currently available interventions for DR/DME, laser photocoagulation and vitrectomy, only target advanced stages of disease. Several biochemical mechanisms, including protein kinase C-beta activation, increased vascular endothelial growth factor production, oxidative stress, and accumulation of intracellular sorbitol and advanced glycosylation end products, may contribute to the vascular disruptions that characterize DR/DME. The inhibition of these pathways holds the promise of intervention for DR at earlier non-sight-threatening stages. To implement new therapies effectively, more individuals will need to be screened for DR/DME at earlier stages-a process requiring both improved technology and interdisciplinary cooperation among physicians caring for patients with diabetes.

  7. Does Hemoglobin Predict Proliferative Diabetic Retinopathy?

    PubMed Central

    Conway, Baqiyyah N; Miller, Rachel G; Klein, Ronald; Orchard, Trevor J

    2009-01-01

    Objective As an elevated erythropoietin has been observed in diabetic retinopathy, we sought to investigate the role of hemoglobin (HGB) in predicting proliferative diabetic retinopathy (PDR). Research Design and Methods We assessed 426 individuals without PDR at baseline (213 men; 213 women) from the Pittsburgh Epidemiology of Diabetes Complications Study, an 18-year prospective cohort study of childhood onset type 1 diabetes. PDR was determined by stereo fundus photography. Cox proportional hazards modeling with stepwise regression was used to determine the independent association of HGB with PDR. Analyses were conducted gender-specifically. Results There were 206 events. Although the incidence of PDR did not vary by gender (48 % in both men and women), in men, HGB exhibited a positive linear relationship with the 18-year incidence of PDR (HR=1.33, 1.10–1.60, p=0.003) while in women HGB exhibited a quadratic relationship with PDR (p=0.0008). After multivariable adjustment for univariately significant covariates, HGB remained significantly predictive of PDR in both men (p=0.004) and women (p=0.04). Conclusion Higher HGB predicts the incidence of PDR in Type 1 diabetes, though the association varies by gender, being linear and positive in men and quadratic in women. PMID:19901215

  8. Inflammation and pharmacological treatment in diabetic retinopathy.

    PubMed

    Kaštelan, Snježana; Tomić, Martina; Gverović Antunica, Antonela; Salopek Rabatić, Jasminka; Ljubić, Spomenka

    2013-01-01

    Diabetic retinopathy (DR), the most common microvascular complication of diabetes mellitus, is estimated to be the leading cause of new blindness in the working population of developed countries. Primary interventions such as intensive glycemic control, strict blood pressure regulation, and lipid-modifying therapy as well as local ocular treatment (laser photocoagulation and pars plana vitrectomy) can significantly reduce the risk of retinopathy occurrence and progression. Considering the limitations of current DR treatments development of new therapeutic strategies, it becomes necessary to focus on pharmacological treatment. Currently, there is increasing evidence that inflammatory processes have a considerable role in the pathogenesis of DR with multiple studies showing an association of various systemic as well as local (vitreous and aqueous fluid) inflammatory factors and the progression of DR. Since inflammation is identified as a relevant mechanism, significant effort has been directed to the development of new concepts for the prevention and treatment of DR acting on the inflammatory processes and the use of pharmacological agents with anti-inflammatory effect. Inhibiting the inflammatory pathway could be an appealing treatment option for DR in future practices, and as further prospective randomized clinical trials accumulate data, the role and guidelines of anti-inflammatory pharmacologic treatments will become clearer.

  9. Photocoagulation as treatment of diabetic retinopathy

    NASA Astrophysics Data System (ADS)

    Sanchez, J.; Fernandez, L.; de Pedraza, Maria L.; Gamella, C.; Santervas, R.

    1992-03-01

    Diabetes Mellitus is a chronic disease that is revealed with a lot of alterations due to factors such as an absolute or relative reduction of the insulin. It is usually accompanied by generalized arteriosclerosis and prepares for certain microvasculares pathologies such as retinopathy, nefropathy, and neuropathy. The first effects of diabetes in the retina seem to act on the capillaries. The functional modifications of the retinal circulation appear before the structural ones. These consist of the blood flux damage and the obligation of the hematorretinal barrier with extravasacy as can be proved in the fluorophotometry of the vitreous humor. Nowadays, medical treatments are more effective and only vitrectomy and photocoagulation are used in diabetic retinopathy. For that, the argon laser and the xenon arch are used. The treatment is usually spread panretine, with coagulation in a grid pattern around the eye, avoiding the macula and other vital structures, and treating the neoformed blood vessels. The rate of grave visual loss in the studies carried out with there techniques was 12 in relation to 28 in the non-treated cases. The most important factors of risk found, were the discal neoformed blood vessels and the hemorrhage of the vitreous humor. Adverse effects were found such as the reduction of visual sharpness and the contrition of the visual field, these are greater in patients treated with the xenon arch than in those treated with the argon laser.

  10. Factors associated to hypertensive heart disease development: a prospective cohort study in Bayamo, Cuba.

    PubMed

    Álvarez Aliaga, Alexis; González Aguilera, Julio César; Maceo Gómez, Liliana Del Rosario

    2016-07-07

    Among the conditions resulting from target organ damage by arterial hypertension, hypertensive cardiopathy is the one that exhibits the highest morbidity and mortality rates. Its prevention should be a target of all high blood pressure medical care programs. To identify risk factors for the development of hypertensive cardiopathy. A prospective cohort study was carried out in hypertensive patients assisted at the specialized arterial hypertension physicians’ offices of the “Carlos Manuel de Céspedes” Specialty Policlinic attached to the General University Hospital, Bayamo Municipality, Granma Province, Cuba, from January 1st, 2000 to December 31st, 2009. Multivariate analysis done to estimate the hazard rate (HR) of developing hypertensive cardiopathy, showed significant independent statistic association for most factors. The first place was occupied by lack of blood pressure control (HR=2.022; 95% CI: 1.659-2.465; p<0.005), followed by hypertension stage 2 (HR=2.015; 95% CI: 1.715-2.366; p<0.005). Another factors with significant HRs were microalbuminuria (HR=1.9; 95% CI: 1.6-2.2) and age over 60 years (HR=1.6; 95% CI: 1.4-1.9). Several risk factors must be considered for the prevention of hypertensive heart disease in high blood pressure patients.

  11. High normal urine albumin-to-creatinine ratio predicts development of hypertension in Korean men.

    PubMed

    Park, Sung Keun; Moon, Soo Young; Oh, Chang-Mo; Ryoo, Jae-Hong; Park, Min Suk

    2014-01-01

    Microalbuminuria is known as a risk factor for hypertension. Recently it was suggested that urine albumin-to-creatinine ratio (UACR), even within the normal range, can be associated with hypertension, but the temporal relationship between normal range UACR and hypertension was not confirmed. Therefore the aim of this study was to verify an association between normal range UACR and the development of hypertension in Korean men. This prospective cohort study was performed on 1,284 initially non-hypertensive Korean men. The total follow-up period was 4,109.5 person-years and the mean follow-up period was 3.2±1.51 years. Cox proportional hazards model was used to estimate the hazard ratios (HR) for the risk of hypertension development. After adjusting for multiple covariates, the HR (95% confidence interval [CI]) for incident hypertension, comparing the second to the fourth quartiles of UACR level to the first quartile, were 1.35 (95% CI: 0.93-1.97), 1.55 (95% CI: 1.07-2.25) and 1.89 (95% CI: 1.31-2.71), respectively (P for trend=0.001). High UACR within the normal range was significantly associated with hypertension development. Furthermore, this association remained significant after adjusting for multiple baseline covariates. 

  12. Cold pressor test as a predictor of the severity of hypertension.

    PubMed

    Loyke, H F

    1995-03-01

    This report examines the cold pressor test (CPT) as it relates to the severity of hypertension. A total of 123 hypertensive patients were studied by physical examination, retinal funduscopy, chest roentgenogram, electrocardiogram, blood urea nitrogen measurement, and urinalysis. Causal and valid basal resting blood pressure determinations were made, followed by immersion of one hand in ice water for 2 minutes. All 21 patients with arteriosclerotic, 78 with essential, and 24 with renal hypertension had hyperreactive responses to the CPT (> 20/20 mm Hg) as compared with the normotensive subjects. The CPT-induced increase in diastolic pressure was significantly higher in hypertensives with left ventricular hypertrophy (LVH). CPT responses were also greater in hypertensives with higher degrees of retinopathy. These findings indicate that the diastolic rise on cold pressor testing can be used as a measure of severity of hypertension, especially in the presence of LVH and severe retinopathy. The CPT is inexpensive and noninvasive and can aid the clinician in managing the hypertensive patient. The CPT may also be useful as a predictor of complications of hypertension in selected individuals.

  13. Short term effect of captopril on microalbuminuria induced by exercise in normotensive diabetics.

    PubMed Central

    Romanelli, G.; Giustina, A.; Cimino, A.; Valentini, U.; Agabiti-Rosei, E.; Muiesan, G.; Giustina, G.

    1989-01-01

    OBJECTIVE--To investigate whether captopril has any effect on microalbuminuria induced by exercise in normotensive diabetic patients with early stage nephropathy. DESIGN--Randomised, double blind, crossover trial. SETTING--Outpatient department. PATIENTS--22 diabetics with stage II nephropathy (urinary albumin excretion rate less than 20 micrograms/min; 15 with type I diabetes and seven with type II), 32 patients with stage III nephropathy (urinary albumin excretion rate 20-200 micrograms/min; 14 with type I diabetes and 18 with type II), and 10 normal subjects. INTERVENTIONS--Four exercise tests on a cycle ergometer: the first two under basal conditions and the third and fourth after subjects had received captopril (two 25 mg doses in 24 hours) or placebo (two tablets in 24 hours). END POINT--Exercised until 90% of maximum heart rate achieved. MEASUREMENTS AND MAIN RESULTS--Mean urinary excretion one hour after the first two exercise tests was 21 micrograms/min in normal subjects, 101 micrograms/min in diabetic patients with stage II nephropathy, and 333 micrograms/min in those with stage III nephropathy. Similar results were obtained after placebo. After captopril the urinary excretion rate one hour after exercise was significantly decreased in diabetics with stage II (36 micrograms/min) and stage III (107 micrograms/min) disease compared with placebo but not in normal subjects. Systolic and diastolic pressures were similar in the three groups after placebo and captopril had been given. CONCLUSIONS--Captopril significantly reduces microalbuminuria induced by exercise in normotensive diabetics without affecting systemic blood pressure. Captopril may reduce renal intracapillary pressure. PMID:2493897

  14. Efficacy of captopril in postponing nephropathy in normotensive insulin dependent diabetic patients with microalbuminuria.

    PubMed Central

    Mathiesen, E R; Hommel, E; Giese, J; Parving, H H

    1991-01-01

    OBJECTIVE--To assess the effectiveness of angiotensin converting enzyme inhibition in preventing the development of diabetic nephropathy (albuminuria greater than 300 mg/24h). DESIGN--Open randomised controlled study of four years' duration. SETTING--Outpatient diabetic clinic in tertiary referral centre. PATIENTS--44 normotensive (mean blood pressure 127/78 (SD 12/10) mm Hg) insulin dependent diabetic patients with persistent microalbuminuria (30-300 mg/24h). INTERVENTIONS--The treatment group (n = 21) was initially given captopril (25 mg/24 h). The dose was increased to 100 mg/24 h during the first 16 months and thiazide was added after 30 months. The remaining 23 patients were left untreated. MAIN OUTCOME MEASURES--Albuminuria, kidney function, development of diabetic nephropathy (albuminuria greater than 300 mg/24 h), and arterial blood pressure. RESULTS--Clinical and laboratory variables were comparable at baseline. Urinary excretion of albumin was gradually reduced from 82 (66-106) to 57 (39-85) mg/24 h (geometric mean (95% confidence interval)) in the captopril treated group, whereas an increase from 105(77-153) to 166 (83-323) mg/24 h occurred in the control group (p less than 0.05). Seven of the untreated patients progressed to diabetic nephropathy, whereas none of the captopril treated patients developed clinical overt diabetic nephropathy (p less than 0.05). Systemic blood pressure, glomerular filtration rate, haemoglobin A1c concentration, and urinary excretion of sodium and urea remained practically unchanged in the two groups. CONCLUSIONS--The findings suggest that angiotensin converting enzyme inhibition postpones the development of clinical overt diabetic nephropathy in normotensive insulin dependent diabetic patients with persistent microalbuminuria. PMID:1860008

  15. Present-day conservative treatment retinopathy of prematurity.

    PubMed

    Monika, Modrzejewska; Katarzyna, Kubasik-Kładna; Leszek, Kuprjanowicz

    2013-01-01

    Retinopathy of prematurity occurs in prematurely born babies. Etiology of disease is multifactorial and frequency of retinopathy of prematurity diagnosis increases. Retinopathy is one of causes for major loss of vision and amaurosis in newborns around the world. Low efficacy of treatment leads to necessity for looking for new solutions and modern therapy use in treatment of this disease. So far, therapies used are: laser and cryotherapy and cases of retina detachment, the course is combined with surgical procedures of sclera and vitrectomy. The aim of the paper was detailed observation of available literature concerning new methods of management in retinopathy of prematurity. Newest reviews on role of vascular endothelial growth factor secreted under the influence of hypoxia indicate that it takes part in angiogenesis and neovascularization. Thus, in retinopathy of prematurity management vitreous application of vascular endothelial growth factor inhibitors such as ranibizumab, bevacizumab are used as supplement or treatment combined with laser therapy or surgical procedures, however there are many controversies on this form of treatment. Recently there has been an interest in vitreous application of Triamcinolon and other experimental substances inhibiting fibro-vascular proliferations in mouse models of retinopathy of prematurity. Hopes connected with high efficacy of retinopathy of prematurity treatment are also related to use of gene therapy, beta-blockers, supplementation with Omega-3 acids, matrix metalloproteinase-2 inhibitors, gold nanoparticles-GNP and anthrax lethal toxin.

  16. Results of a diabetic retinopathy screening. Risk markers analysis.

    PubMed

    Ancochea, G; Martín Sánchez, M D

    2016-01-01

    To identify risk markers for retinopathy in patients from our geographic area, and to compare them with those published in other studies. To design a screening interval strategy, taking into account these results, and compare it with intervals suggested in published studies. Cross-sectional observational study on 383 diabetic patients with no previous retinopathy diagnosis, who were screened for diabetic retinopathy. An analysis was made on the possible association between patient factors and presence of retinopathy. A greater probability for finding retinopathy in diabetic patients was associated to insulin treatment in our study, with a statistical significance level of 95%. In patients with less than 10year onset of their diabetes, only mild retinopathy without macular oedema was found. Insulin treatment and time of onset of diabetes should be taken into account when designing efficient screening strategies for diabetic retinopathy. Copyright © 2015 Sociedad Española de Oftalmología. Published by Elsevier España, S.L.U. All rights reserved.

  17. Diabetic Retinopathy in Patients with Diabetic Nephropathy: Development and Progression

    PubMed Central

    Jeng, Chi-Juei; Hsieh, Yi-Ting; Yang, Chung-May; Yang, Chang-Hao; Lin, Cheng-Li

    2016-01-01

    The purpose of current study aims to investigate the development and progression of diabetic retinopathy (DR) in patients with diabetic nephropathy (DN) in a nationwide population-based cohort in Taiwan. Newly diagnosed DN patients and age- and sex-matched controls were identified from the Taiwanese Longitudinal Health Insurance Database from 2000 to 2010. We studied the effects of age, sex, hypertension, dyslipidemia, diabetic polyneuropathy (DPN), and medications on the development of nonproliferative DR (NPDR), proliferative DR (PDR), and diabetic macular edema (DME) in patients with DN. Cox proportional hazard regression analyses were used to estimate the adjusted hazard ratios (HRs) of the development of DR. Our results show that the adjusted HRs of NPDR and PDR were 5.01 (95% confidence interval (CI) = 4.68–5.37) and 9.7 (95% CI = 8.15–11.5), respectively, in patients with DN as compared with patients in the non-DN cohort. At 5-year follow-up, patients with DN showed an increased HR of NPDR progression to PDR (HR = 2.26, 95% CI = 1.68–3.03), and the major comorbidities were hypertension (HR = 1.23, 95% CI = 1.10–1.38 with NPDR; HR = 1.33, 95% CI = 1.02–1.72 with PDR) and DPN (HR = 2.03, 95% CI = 1.72–2.41 in NPDR; HR = 2.95, 95% CI = 2.16–4.03 in PDR). Dyslipidemia increased the HR of developing NPDR but not PDR or DME. Moreover, DN did not significantly affect DME development (HR = 1.47, 95% CI = 0.87–2.48) or progression (HR = 0.37, 95% CI = 0.11–1.20). We concluded that DN was an independent risk factor for DR development and progression; however, DN did not markedly affect DME development in this study, and the potential association between these disorders requires further investigation. PMID:27564383

  18. Hypertension screening

    NASA Technical Reports Server (NTRS)

    Foulke, J. M.

    1975-01-01

    An attempt was made to measure the response to an announcement of hypertension screening at the Goddard Space Center, to compare the results to those of previous statistics. Education and patient awareness of the problem were stressed.

  19. Pulmonary Hypertension

    MedlinePlus

    Pulmonary hypertension (PH) is high blood pressure in the arteries to your lungs. It is a serious condition. If you have ... and you can develop heart failure. Symptoms of PH include Shortness of breath during routine activity, such ...

  20. Portal Hypertension

    MedlinePlus

    ... Affairs, Sidney Kimmel Medical College at Thomas Jefferson University Get the Quick Facts For this topic NOTE: ... at least 6 months) Drinking large amounts of alcohol over a long period of time Portal hypertension ...

  1. Hypertension screening

    NASA Technical Reports Server (NTRS)

    Foulke, J. M.

    1975-01-01

    An attempt was made to measure the response to an announcement of hypertension screening at the Goddard Space Center, to compare the results to those of previous statistics. Education and patient awareness of the problem were stressed.

  2. Recent Developments in Laser Treatment of Diabetic Retinopathy

    PubMed Central

    Yun, Samuel H.; Adelman, Ron A.

    2015-01-01

    Laser photocoagulation has been the mainstay of diabetic retinopathy treatment since its development in mid-20th century. With the advent of antivascular endothelial growth factor therapy, the role of laser therapy appeared to be diminished, however many advances in laser technology have been developed since. This review will describe recent advances in laser treatment of diabetic retinopathy including pattern scan laser, short-pulse duration and a reduced fluence laser, and navigated laser system for proliferative diabetic retinopathy and macular edema. PMID:25949072

  3. Portal hypertension.

    PubMed

    Garcia-Tsao, Guadalupe

    2002-05-01

    Portal hypertension is the main complication of cirrhosis and is responsible for its most common complications: variceal hemorrhage, ascites, and portosystemic encephalopathy. Portal hypertension is the result of increased intrahepatic resistance and increased portal venous inflow. Vasodilatation (splanchnic and systemic) and the hyperdynamic circulation are hemodynamic abnormalities typical of cirrhosis and portal hypertension. Gastroesophageal varices result almost solely from portal hypertension, although the hyperdynamic circulation contributes to variceal growth and hemorrhage. Ascites results from sinusoidal hypertension and sodium retention, which is in turn secondary to vasodilatation and activation of neurohumoral systems. Hepatic hydrothorax results from the passage of ascites across the diaphragm and into the pleural space. The hepatorenal syndrome represents the result of extreme vasodilatation with an extreme decrease in effective blood volume that leads to maximal activation of vasoconstrictive systems, renal vasoconstriction, and renal failure. Spontaneous bacterial peritonitis is a potentially lethal infection of ascites that occurs in the absence of a local source of infection. Portosystemic encephalopathy is a consequence of both portal hypertension (shunting of blood through portosystemic collaterals) and hepatic insufficiency resulting in the accumulation of neurotoxins in the brain.

  4. Angiotensin II-related hypertension and eye diseases

    PubMed Central

    Marin Garcia, Pablo Jesus; Marin-Castaño, Maria Encarna

    2014-01-01

    Systemic vascular disease, especially hypertension, has been suspected as a risk factor for some eye diseases including, diabetic retinopathy and age-related macular degeneration. Hypertension can contribute to chronic diseases by hemodynamic injury and/or cellular actions induced by hypertension-related hormones or growth factors. Among the most important is Angiotensin II (Ang II), which controls blood pressure and induces different cellular functions that may be dependent or independent of its effect on blood pressure. Importantly, as is true for heart, kidney and other organs, the renin-angiotensin system (RAS) is present in the eye. So, even in the absence of hypertension, local production of Ang II could be involved in eye diseases. The goal of this manuscript is to review the most relevant scientific evidence supporting the role of the RAS activation, in the development of age-related macular degeneration and diabetic retinopathy, and highlight the importance of Ang II in the etiology of these diseases. PMID:25276298

  5. Incidence, risk factors, and morphology in operating microscope light retinopathy

    SciTech Connect

    Khwarg, S.G.; Linstone, F.A.; Daniels, S.A.; Isenberg, S.J.; Hanscom, T.A.; Geoghegan, M.; Straatsma, B.R.

    1987-03-15

    A review of 135 consecutive cataract operations identified ten cases (7.4%) of operating microscope light retinopathy. Ophthalmoscopically, these light retinopathy lesions appeared as a focal pigment epithelial change with varying degrees of pigment clumping in the center. Fluorescein angiography accentuated the lesion by demonstrating a sharply demarcated transmission defect, occasionally with multiple satellite lesions. The shape of the lesion matched the shape of the illuminating source of the particular operating microscope used during the surgery. The most significant risk factor associated with the production of these light retinopathy lesions was prolonged operating time. Mean total operating time for the ten patients with light retinopathy was 51 minutes longer than for those without (P less than .0001). Other significant associated factors were the presence of diabetes mellitus (P less than .03), younger age (P less than .05), and the use of hydrochlorothiazide (P less than .04).

  6. Evaluation of the Treatment of Diabetic Retinopathy A Research Project

    ERIC Educational Resources Information Center

    Kupfer, Carl

    1973-01-01

    Evaluated is the treatment of diabetic retinopathy (blindness due to ruptured vessels of the retina as a side effect of diabetes), and described is a research project comparing two types of photocoagulation treatment. (DB)

  7. Is medical treatment for diabetic retinopathy still an unreal dream?

    PubMed

    Giusti, C

    2002-12-01

    Diabetic retinopathy is a highly specific vascular complication of both type 1 and type 2 diabetes, estimated to be the most frequent cause of new cases of blindness in the working population of the Western world. The prevalence of retinopathy is strongly related to the duration of diabetes and glycemic control, even though a multifactorial pathogenesis should be probably considered in genetically susceptible subjects. Intensive diabetes management, with the goal of achieving near-normal glycemia, has been shown to prevent and/or delay the onset of diabetic retinopathy and laser photocoagulation has an established clinical efficacy in preventing visual loss. However, as laser scars always destroy the retinal anatomy permanently, a medical approach to nonproliferative retinopathy should be preferred if its clinical efficacy could be demonstrated. In this paper, recently published reports supporting this hypothesis are reviewed and their conclusions critically discussed.

  8. Retinopathy of Prematurity: AIIMS, New Delhi Experience.

    PubMed

    Sivanandan, Sindhu; Chandra, Parijat; Deorari, Ashok K; Agarwal, Ramesh

    2016-11-07

    Retinopathy of prematurity (ROP) is a leading cause of potentially avoidable childhood blindness worldwide. With improvement in neonatal care, more preterm infants are surviving with a resultant increase in the number of ROP cases. In low-middle income countries, the disease epidemiology is characterized by the occurrence of ROP at higher birthweight in premature babies with greater severity at presentation. In this article, we describe the ROP screening and management program at the All India Institute of Medical Sciences (AIIMS), New Delhi that has evolved over last three decades. The AIIMS model demonstrates that with high-quality perinatal - neonatal care and a stable ROP program, severe ROP is a preventable disease in bigger preterm neonates (28 weeks or higher gestation) and largely remains a disease of extremely low gestational age babies- a phenomenon similar to that noted in high-income countries.

  9. Acute eclipse retinopathy: a small case series.

    PubMed

    Khatib, Nur; Knyazer, Boris; Lifshitz, Tova; Levy, Jaime

    2014-01-01

    We present four young patients with acute severe solar retinopathy after observation of the total eclipse on January 4, 2011 without appropriate eye protection. Funduscopic findings were accompanied by optical coherence tomography (OCT) investigation of the macula. All our patients were young (range 14-29 years). In three of the four patients we have been able to repeat OCT evaluation revealing that the retinal changes were reversible, but delineating mild pathology in the retinal pigment epithelium and photoreceptors. Best-corrected visual acuity in the fourth case was 6/24. In addition, macular edema, which has been previously described in literature, could not be demonstrated by OCT. In the two cases we performed an early fluorescein angiogram, no pathology was seen. Copyright © 2013 Spanish General Council of Optometry. Published by Elsevier Espana. All rights reserved.

  10. Diabetic Retinopathy: Vascular and Inflammatory Disease

    PubMed Central

    Semeraro, F.; Cancarini, A.; dell'Omo, R.; Rezzola, S.; Romano, M. R.; Costagliola, C.

    2015-01-01

    Diabetic retinopathy (DR) is the leading cause of visual impairment in the working-age population of the Western world. The pathogenesis of DR is complex and several vascular, inflammatory, and neuronal mechanisms are involved. Inflammation mediates structural and molecular alterations associated with DR. However, the molecular mechanisms underlying the inflammatory pathways associated with DR are not completely characterized. Previous studies indicate that tissue hypoxia and dysregulation of immune responses associated with diabetes mellitus can induce increased expression of numerous vitreous mediators responsible for DR development. Thus, analysis of vitreous humor obtained from diabetic patients has made it possible to identify some of the mediators (cytokines, chemokines, and other factors) responsible for DR pathogenesis. Further studies are needed to better understand the relationship between inflammation and DR. Herein the main vitreous-related factors triggering the occurrence of retinal complication in diabetes are highlighted. PMID:26137497

  11. Visual complications in diabetes mellitus: beyond retinopathy.

    PubMed

    Khan, A; Petropoulos, I N; Ponirakis, G; Malik, R A

    2017-04-01

    Diabetic retinopathy is the most common cause of vision loss in people with diabetes mellitus; however, other causes of visual impairment/loss include other retinal and non-retinal visual problems, including glaucoma, age-related macular degeneration, non-arteritic anterior ischaemic optic neuropathy and cataracts. Additionally, when a person with diabetes complains of visual disturbance despite a visual acuity of 6/6, abnormalities in refraction, contrast sensitivity, straylight and amplitude of accommodation should be considered. We review and highlight these visual problems for physicians who manage people with diabetes to ensure timely referral and treatment to limit visual disability, which can have a significant impact on daily living, especially for those participating in sports and driving.

  12. Acute eclipse retinopathy: A small case series

    PubMed Central

    Khatib, Nur; Knyazer, Boris; Lifshitz, Tova; Levy, Jaime

    2014-01-01

    We present four young patients with acute severe solar retinopathy after observation of the total eclipse on January 4, 2011 without appropriate eye protection. Funduscopic findings were accompanied by optical coherence tomography (OCT) investigation of the macula. All our patients were young (range 14–29 years). In three of the four patients we have been able to repeat OCT evaluation revealing that the retinal changes were reversible, but delineating mild pathology in the retinal pigment epithelium and photoreceptors. Best-corrected visual acuity in the fourth case was 6/24. In addition, macular edema, which has been previously described in literature, could not be demonstrated by OCT. In the two cases we performed an early fluorescein angiogram, no pathology was seen. PMID:25323644

  13. Retinopathy and Cognitive Impairment in Adults With CKD

    PubMed Central

    Yaffe, Kristine; Ackerson, Lynn; Hoang, Tina D.; Go, Alan S.; Maguire, Maureen G.; Ying, Gui-Shuang; Daniel, Ebenezer; Bazzano, Lydia A.; Coleman, Martha; Cohen, Debbie L.; Kusek, John W.; Ojo, Akinlolu; Seliger, Stephen; Xie, Dawei; Grunwald, Juan E.

    2014-01-01

    Background Retinal microvascular abnormalities have been associated with cognitive impairment, possibly serving as a marker of cerebral small vessel disease. This relationship has not been evaluated among persons with chronic kidney disease (CKD), a condition associated with increased risk of both retinal pathology and cognitive impairment. Study Design Cross-sectional study Setting & Participants 588 participants ≥ 52 years old with CKD in the Chronic Renal Insufficiency Cohort (CRIC) Study Predictor Retinopathy graded using the Early Treatment Diabetic Retinopathy Study severity scale and diameters of retinal vessels. Outcomes Neuropsychological battery of six cognitive tests Measurements Logistic regression models were used to evaluate the association of retinopathy, individual retinopathy features, and retinal vessel diameters with cognitive impairment (≤1 SD from the mean), and linear regression models were used to compare cognitive test scores across levels of retinopathy adjusting for age, race, sex, education, and medical comorbidities. Results The mean age of the cohort was 65.3 +/− 5.6 (SD) years; 51.9% were non-White, and 52.6% were male. The prevalence of retinopathy was 30.1% and 14.3% for cognitive impairment. Compared to those without retinopathy, participants with retinopathy had increased likelihood of cognitive impairment on executive function (35.1% vs. 11.5%; OR, 3.4; 95% CI, 2.0-6.0), attention (26.7% vs. 7.3%; OR, 3.0; 95% CI, 1.8-4.9), and naming (26.0% vs. 10.0%; OR, 2.1; 95% CI, 1.2-3.4) after multivariable adjustment. Increased level of retinopathy was also associated with lower cognitive performance on executive function and attention. Microaneurysms were associated with cognitive impairment on some domains, but there were no significant associations with other retinal measures after multivariable adjustment. Limitations Unknown temporal relationship between retinopathy and impairment. Conclusions In adults with CKD, retinopathy is

  14. Association of Salivary Osteopontin Levels with Glycaemic Status and Microalbuminuria - in Patients with Type 2 Diabetes Mellitus

    PubMed Central

    Rajagambeeram, Reeta; Venkatkumar, Shruthi; Vijayan, Mohana Valli; Murugaiyan, Sathish Babu; Gopal, Shyam Prakash; Ramsamy, Sathiya; Alwar, Velayutharaj

    2016-01-01

    Introduction The monitoring of glycaemic status in patients with T2DM is mainly through blood tests (Fasting plasma glucose and HbA1c), which are invasive and involves painful pricks. This leads to poor patient compliance and soon could lead to various micro and macro vascular complications, which hamper the quality of life. There are no sensitive and specific markers to predict these complications at the earliest. Sialochemistry has recently gained attention for monitoring chronic diseases. Osteopontin is a phospho-glycoprotein molecule, elevated in many inflammatory conditions. Aim The aim of the study was to evaluate the role of serum and salivary osteopontin in Type 2 Diabetes mellitus (T2DM). Materials and Methods In this case-control study, we recruited 33 cases of T2DM and 31 age and gender matched healthy controls. Body Mass Index (BMI), Waist/Hip Ratio (WHR), Waist Circumference (WC) and blood pressure was recorded. Fasting Plasma Glucose (FPG), salivary glucose, HbA1c, microalbuminuria, systolic BP, serum and salivary osteopontin levels were estimated. Results FPG, salivary glucose, HbA1c, microalbuminuria, systolic BP, BMI, waist / hip ratio serum and salivary osteopontin levels were significantly high in T2DM cases compared to control subjects. Serum and salivary osteopontin levels were significantly correlated with HbA1c and microalbuminuria in T2DM cases. Conclusion Serum and salivary osteopontin levels are significantly elevated in subjects with T2DM and are associated with glycaemic control and microalbuminuria. PMID:27656430

  15. Conjunctival Microvascular Hemodynamics in Sickle Cell Retinopathy

    PubMed Central

    Valeshabad, Ali Kord; Wanek, Justin; Zelkha, Ruth; Lim, Jennifer I.; Camardo, Nicole; Gaynes, Bruce; Shahidi, Mahnaz

    2014-01-01

    Purpose To determine alterations in bulbar conjunctival microvascular hemodynamics in sickle cell retinopathy (SCR) subjects with focal macular thinning (FMT). Methods Conjunctival microcirculation imaging and spectral domain optical coherence tomography (SD-OCT) were performed in 22 subjects (eyes) diagnosed with SCR. Based on evaluation of SD-OCT retinal thickness maps, eyes were assigned to one of two groups: with or without FMT. Conjunctival venule diameter and axial blood velocity were measured in multiple venules in each eye by customized image analysis algorithms. Measurements were then categorized into two vessel size groups (vessel size 1 and 2) and compared between FMT groups. A Pearson correlation coefficient was computed to assess the relationship between retinal thickness and axial blood velocity. Results Mean age, hematocrit, sickle cell hemoglobin type, and median retinopathy score were not significantly different between the two groups (p ≥ 0.1). Retinal thickness in parafoveal and perifoveal temporal subfields was significantly lower in eyes with FMT as compared to eyes without FMT (p ≤ 0.04). There was a significant effect of FMT on axial blood velocity (P = 0.04), while the effect of vessel size was not significant (P = 0.4). In vessel size 1, axial blood velocity was lower in eyes with FMT than in eyes without FMT (P = 0.03), while in vessel size 2, there was no statistically significant difference between FMT groups (P = 0.1). In vessel size 1, there was a significant positive correlation between axial blood velocity and retinal thickness in the perifoveal (r = 0.48, P = 0.02) and parafoveal (r = 0.43, P = 0.04) temporal subfields. Conclusion Conjunctival axial blood velocity in small venules is reduced in SCR subjects with focal macular thinning. PMID:25429907

  16. Endothelial Progenitor Cells in Diabetic Retinopathy

    PubMed Central

    Lois, Noemi; McCarter, Rachel V.; O’Neill, Christina; Medina, Reinhold J.; Stitt, Alan W.

    2014-01-01

    Diabetic retinopathy (DR) is a leading cause of visual impairment worldwide. Patients with DR may irreversibly lose sight as a result of the development of diabetic macular edema (DME) and/or proliferative diabetic retinopathy (PDR); retinal blood vessel dysfunction and degeneration plays an essential role in their pathogenesis. Although new treatments have been recently introduced for DME, including intravitreal vascular endothelial growth factor inhibitors (anti-VEGFs) and steroids, a high proportion of patients (~40–50%) do not respond to these therapies. Furthermore, for people with PDR, laser photocoagulation remains a mainstay therapy despite this being an inherently destructive procedure. Endothelial progenitor cells (EPCs) are a low-frequency population of circulating cells known to be recruited to sites of vessel damage and tissue ischemia where they promote vascular healing and re-perfusion. A growing body of evidence suggests that the number and function of EPCs are altered in patients with varying degrees of diabetes duration, metabolic control, and in the presence or absence of DR. Although there are no clear-cut outcomes from these clinical studies, there is mounting evidence that some EPC sub-types may be involved in the pathogenesis of DR and may also serve as biomarkers for disease progression and stratification. Moreover, some EPC sub-types have considerable potential as therapeutic modalities for DME and PDR in the context of cell therapy. This study presents basic clinical concepts of DR and combines this with a general insight on EPCs and their relation to future directions in understanding and treating this important diabetic complication. PMID:24782825

  17. Increment Threshold Functions in Retinopathy of Prematurity

    PubMed Central

    Hansen, Ronald M.; Moskowitz, Anne; Bush, Jennifer N.; Fulton, Anne B.

    2016-01-01

    Purpose To assess scotopic background adaptation in subjects with a history of preterm birth and retinopathy of prematurity (ROP). Retinopathy of prematurity is known to have long-term effects on rod photoreceptor and rod mediated postreceptor retinal function. Methods Rod-mediated thresholds for detection of 3° diameter, 50 ms stimuli presented 20° from fixation were measured using a spatial forced choice method in 36 subjects (aged 9–17 years) with a history of preterm birth and 11 age similar term-born subjects. Thresholds were measured first in the dark-adapted condition and then in the presence of 6 steady background lights (−2.8 to +2.0 log scot td). A model of the increment threshold function was fit to each subject's thresholds to estimate the dark-adapted threshold (TDA) and the Eigengrau (A0, the background that elevates threshold 0.3 log unit above TDA). Results In subjects with a history of severe ROP, both TDA and A0 were significantly elevated relative to those in former preterms who never had ROP and term-born control subjects. Subjects who had mild ROP had normal TDA but elevated A0. Neither TDA nor A0 differed significantly between former preterms who never had ROP and term-born controls. Conclusions The results suggest that in severe ROP, threshold is affected at a preadaptation site, possibly the rod outer segment. In mild ROP, changes in the Eigengrau may reflect increased intrinsic noise in the photoreceptor or postreceptor circuitry or both. PMID:27145476

  18. DREAM: diabetic retinopathy analysis using machine learning.

    PubMed

    Roychowdhury, Sohini; Koozekanani, Dara D; Parhi, Keshab K

    2014-09-01

    This paper presents a computer-aided screening system (DREAM) that analyzes fundus images with varying illumination and fields of view, and generates a severity grade for diabetic retinopathy (DR) using machine learning. Classifiers such as the Gaussian Mixture model (GMM), k-nearest neighbor (kNN), support vector machine (SVM), and AdaBoost are analyzed for classifying retinopathy lesions from nonlesions. GMM and kNN classifiers are found to be the best classifiers for bright and red lesion classification, respectively. A main contribution of this paper is the reduction in the number of features used for lesion classification by feature ranking using Adaboost where 30 top features are selected out of 78. A novel two-step hierarchical classification approach is proposed where the nonlesions or false positives are rejected in the first step. In the second step, the bright lesions are classified as hard exudates and cotton wool spots, and the red lesions are classified as hemorrhages and micro-aneurysms. This lesion classification problem deals with unbalanced datasets and SVM or combination classifiers derived from SVM using the Dempster-Shafer theory are found to incur more classification error than the GMM and kNN classifiers due to the data imbalance. The DR severity grading system is tested on 1200 images from the publicly available MESSIDOR dataset. The DREAM system achieves 100% sensitivity, 53.16% specificity, and 0.904 AUC, compared to the best reported 96% sensitivity, 51% specificity, and 0.875 AUC, for classifying images as with or without DR. The feature reduction further reduces the average computation time for DR severity per image from 59.54 to 3.46 s.

  19. Plasma prekallikrein as a risk factor for diabetic retinopathy.

    PubMed

    Kedzierska, Karolina; Ciechanowski, Kazimierz; Gołembiewska, Edyta; Safranow, Krzysztof; Ciechanowicz, Andrzej; Domański, Leszek; Myślak, Marek; Róźański, Jacek

    2005-01-01

    The aim of the study was to verify the hypothesis that in diabetes there is an increased activation of coagulation system leading in consequence to diabetic retinopathy. Thirty three healthy subjects (controls, 16 males and 17 females) and 35 patients with diabetes type 1 (15 males and 20 females) were examined. We monitored plasma prekallikrein (PPK), glycemia, fructosamine, glycosylated hemoglobin, activated partial thromboplastin time (PTT), INR, fibrinolysis in euglobulins time (FET), level of antithrombin III (AT III), fibrinogen (Fb) and fibrinogen degradation products (FDP). In diabetic patients without retinopathy, PKK concentration was 16% higher (p <0.005), in patients with background retinopathy 33% higher (p <0.001), and in patients with proliferative retinopathy PKK concentration was 50% higher (p <0.001) than in controls. In the subgroup of patients with proliferative retinopathy PTT was significantly shorter (p <0.001), and FET was significantly longer (p <0.001) than in control. In patients with diabetes higher FDP concentrations were found than in controls (p <0.05). Significant correlations were found between PPK and fructosamine levels in all diabetic patients (R(S)=+0.57 p <0.001), in diabetic patients without retinopathy (R(S)=+0.61, p <0.05), and in diabetic patients with retinopathy (R(S)=+0.62, p <0.005). We found negative correlation between PPK concentration and PTT (R(S)=-0.43, p <0.001) and positive correlation between PPK concentration and FET (R(S)=+0.59, p <0.00001) in the entire study group. The occurrence of diabetic retinopathy is connected with higher levels of plasma prekallikrein.

  20. Purtscher-like retinopathy in systemic lupus erythematosus.

    PubMed

    Wu, Chan; Dai, Rongping; Dong, Fangtian; Wang, Qian

    2014-12-01

    To investigate clinical characteristics of Purtscher-like retinopathy and its clinical implications among patients with systemic lupus erythematosus (SLE). Observational case series. setting: Tertiary medical center. patient population: Patients with SLE who were diagnosed with Purtscher-like retinopathy between 2002 and 2013. observation procedures: Assessment and follow-up in the ophthalmology department. main outcome measure: Visual acuity and funduscopic examination at presentation and at 6 month follow-up, with analysis of the association between Purtscher-like retinopathy and other systemic involvement of SLE and overall disease activity. Among 5688 patients with SLE evaluated, 8 cases of Purtscher-like retinopathy were diagnosed. Typical fundus abnormalities included Purtscher flecken, cotton-wool spots, retinal hemorrhages, macular edema, optic disk swelling, and a pseudo-cherry red spot. Fluorescein angiography abnormalities included areas of capillary nonperfusion corresponding to the retinal whitening, late leakage, peripapillary staining, precapillary occlusion, and slower filling of vessels. The prevalence of central nervous system lupus was significantly higher among those with Purtscher-like retinopathy (6/8) than among 240 patients randomly sampled from those without Purtscher-like retinopathy. A very high SLE Disease Activity Index (≥20) was present in all 8 patients with Purtscher-like retinopathy. All patients received corticosteroids combined with immunosuppressants. For the majority of patients, optic atrophy developed during follow-up with persistent low visual acuity. As a rare and severe ophthalmic complication of SLE, Purtscher-like retinopathy was associated with central nervous system lupus and highly active disease. Visual acuity recovery was usually poor despite prompt treatment. Copyright © 2014 Elsevier Inc. All rights reserved.

  1. Skin collagen pentosidine and fluorescence in diabetes were predictors of retinopathy progression and creatininemia increase already 6years after punch-biopsy.

    PubMed

    Sternberg, Michel; M'bemba, Jocelyne; Urios, Paul; Borsos, Anne-Marie; Selam, Jean-Louis; Peyroux, Jacques; Slama, Gérard

    2016-02-01

    Advanced glycation end products (AGEs) of collagens appear to contribute to microvascular complications in diabetes. Do high concentrations of AGEs in skin collagen predict accelerated progression of these complications after 6 years and indicate the need for tighter anti-diabetic treatment? We measured two AGE parameters in collagen extracted from skin punch-biopsies: pentosidine and fluorescence at 370/440nm, as markers and predictors of microvascular complications, in 30 patients with diabetes (14 type-1, 16 type-2) without renal insufficiency, and in age- and gender-matched normoglycemic controls, followed at Hôtel-Dieu in Paris. At the time of biopsy, marked increases in pentosidine (p=0.0014) and fluorescence (p=0.0001) expressed per collagen hydroxyproline, were found in the patients with diabetes versus the controls. A significant effect of age was found for pentosidine, but not fluorescence, measurements in the normoglycemic controls. Therefore pentosidine but not fluorescence results were corrected for age in the patients. Pentosidine and fluorescence were correlated with diabetes duration. Fluorescence was significantly dependent on retinopathy presence and score in type-1 and type-2 diabetes, whereas pentosidine was not. Fluorescence was correlated with microalbuminuria only in type-1 diabetes. Neither fluorescence nor pentosidine were correlated with creatininemia. Already six years after biopsy, retinopathy score progression and creatininemia increase were significantly correlated with initial pentosidine and fluorescence measurements. These AGEs are good predictors of progression of microvascular complications and appear to be pathogenic. High skin concentrations of AGEs should induce tighter anti-diabetic treatment. Copyright © 2015 The Canadian Society of Clinical Chemists. Published by Elsevier Inc. All rights reserved.

  2. Hypertensive Cardiovascular and Renal Disease and Target Organ Damage: Lessons from Animal Models

    PubMed Central

    Susic, Dinko; Frohlich, Edward D.

    2011-01-01

    This brief review discusses some aspects of hypertensive damage to the kidneys and cardiovascular system. A comparison of renal and cardiac manifestations of hypertensive disease between results of clinical and experimental studies was made, with a major focus on the possible role of salt and the renin-angiotensin system (RAS) in inducing target organ damage. Thus, some degree of renal impairment is often present in patients with essential hypertension, varying from microalbuminuria to end-stage renal disease, whereas in rats with spontaneous hypertension only slight renal damage is seen in old rats with little evidence of renal failure. Since renal damage in hypertensive rats is induced when they are exposed to increased salt intake, we suggested that salt may also account for kidney injury in hypertensive patients. Similarly, cardiac damage is aggravated in hypertensive human beings and rats when given salt excess. We further presented evidence that the RAS may mediate adverse cardiac and renal effects of excessive salt intake. Finally, we also discussed some aspects of the cardiovascular physiology in the giraffe, the only mammal that in comparison with the human being has extremely high pressure at the level of the heart and kidneys but no target organ damage. PMID:22258536

  3. Hypertensive Cardiovascular and Renal Disease and Target Organ Damage: Lessons from Animal Models.

    PubMed

    Susic, Dinko; Frohlich, Edward D

    2011-01-01

    This brief review discusses some aspects of hypertensive damage to the kidneys and cardiovascular system. A comparison of renal and cardiac manifestations of hypertensive disease between results of clinical and experimental studies was made, with a major focus on the possible role of salt and the renin-angiotensin system (RAS) in inducing target organ damage. Thus, some degree of renal impairment is often present in patients with essential hypertension, varying from microalbuminuria to end-stage renal disease, whereas in rats with spontaneous hypertension only slight renal damage is seen in old rats with little evidence of renal failure. Since renal damage in hypertensive rats is induced when they are exposed to increased salt intake, we suggested that salt may also account for kidney injury in hypertensive patients. Similarly, cardiac damage is aggravated in hypertensive human beings and rats when given salt excess. We further presented evidence that the RAS may mediate adverse cardiac and renal effects of excessive salt intake. Finally, we also discussed some aspects of the cardiovascular physiology in the giraffe, the only mammal that in comparison with the human being has extremely high pressure at the level of the heart and kidneys but no target organ damage.

  4. Managing hypertension in diabetic patients – focus on trandolapril/verapamil combination

    PubMed Central

    Sharma, Sanjib Kumar; Ruggenenti, Piero; Remuzzi, Giuseppe

    2007-01-01

    Hypertensive diabetes individuals are at higher risk for cardiovascular events and progression to end stage renal disease. Several well conducted clinical trials indicate that aggressive treatment of hypertension in individual with diabetes reduces these complications. Combinations of two or more antihypertensive drugs are frequently required to reach the target blood pressure and to improve the cardiovascular and renal outcomes in these patients. There are physiological and clinical rationales for renin-angiotensin system blockade in hypertensive diabetics. Trandolapril/verapamil sustained released (SR) is a fixed-dose combination of trandolapril and a sustained release formulation of verapamil and indicated in treatment of hypertension in patients who require more than one drug to reach target blood pressure. The antihypertensive efficacy of trandolapril/verapamil SR has been evaluated extensively in large trials. In the INVEST trial, a verapamil SR-based treatment strategy that included trandolapril in most patients was effective in reducing the primary outcome in hypertensive patients with coronary artery disease. The new onset of diabetes was also significantly lower in the verapamil SR/trandolapril treatment group in comparison with those on the atenolol/hydroclorothiazide treatment group. The BErgamo NEphrologic DIabetes Complications Trial (BENEDICT) documented that in hypertensive diabetes and normoalbuminuria, trandolapril plus verapamil or trandolapril alone delayed the onset of microalbuminuria independent of their blood pressure-reducing effect. Thus, trandolapril/verapamil is an effective option for treatment of hypertensive diabetes patients requiring more than one agent to achieve target blood pressure. PMID:17969376

  5. Early diagnosis of diabetic retinopathy in primary care

    PubMed Central

    Jimenez-Baez, Maria Valeria; Barcenas-Contreras, Rodolfo; Morales Montoya, Carlos; Espinosa-Garcia, Laura Fatima

    2015-01-01

    Objective: To evaluate the impact of a strategy for early detection of diabetic retinopathy in patients with type 2 diabetes mellitus (DMT2) in Quintana Roo, México. Methods: Study transversal, observational, prospective, analytical, eight primary care units from Mexican Social Security Institute in the northern delegation of the State of Quintana Roo, Mexico were included. A program for early detection of diabetic retinopathy (DR) in adult 376,169 was designed. Were diagnosed 683 cases of type 2 diabetes, in 105 patients randomized was conducted to direct ophthalmoscopy were subjected to a secondary hospital were assigned. Will determine the degree of diabetic retinopathy and macular edema was performed. Results: In population were 55.2% female, mean age 48+11.1 years, 23.8 % had some degree of DR, 28.0% with mild non- proliferative diabetic retinopathy 48.0 % moderate 16.0% and severe and 8.0% showed proliferative diabetic retinopathy. Those over age 30 are 2.8 times more risk of developing DR, OR= 2.8; 95%CI: 0.42-18.0, and OR= 1.7; 95%CI: 1.02-2.95 women. Conclusions: The implementation of programs aimed at the early detection of debilitating conditions such as diabetic retinopathy health impact beneficiaries, effective links between primary care systems and provide second level positive health outcomes for patient diseases. PMID:26019380

  6. The spectrum of retinopathy in adults with Plasmodium falciparum malaria.

    PubMed

    Maude, Richard J; Beare, Nicholas A V; Abu Sayeed, Abdullah; Chang, Christina C; Charunwatthana, Prakaykaew; Faiz, M Abul; Hossain, Amir; Yunus, Emran Bin; Hoque, M Gofranul; Hasan, Mahtab Uddin; White, Nicholas J; Day, Nicholas P J; Dondorp, Arjen M

    2009-07-01

    A specific retinopathy has been described in African children with cerebral malaria, but in adults this has not been extensively studied. Since the structure and function of the retinal vasculature greatly resembles the cerebral vasculature, study of retinal changes can reveal insights into the pathophysiology of cerebral malaria. A detailed observational study of malarial retinopathy in Bangladeshi adults was performed using high-definition portable retinal photography. Retinopathy was present in 17/27 adults (63%) with severe malaria and 14/20 adults (70%) with cerebral malaria. Moderate or severe retinopathy was more frequent in cerebral malaria (11/20, 55%) than in uncomplicated malaria (3/15, 20%; P=0.039), bacterial sepsis (0/5, 0%; P=0.038) or healthy controls (0/18, 0%; P<0.001). The spectrum of malarial retinopathy was similar to that previously described in African children, but no vessel discolouration was observed. The severity of retinal whitening correlated with admission venous plasma lactate (P=0.046), suggesting that retinal ischaemia represents systemic ischaemia. In conclusion, retinal changes related to microvascular obstruction were common in adults with severe falciparum malaria and correlated with disease severity and coma, suggesting that a compromised microcirculation has important pathophysiological significance in severe and cerebral malaria. Portable retinal photography has potential as a valuable tool to study malarial retinopathy.

  7. Type 2 diabetes mellitus with hypertension at primary healthcare level in Malaysia: are they managed according to guidelines?

    PubMed

    Chan, G C

    2005-03-01

    A study was conducted at primary healthcare level in the Melaka Tengah district of Malaysia to determine whether hypertension in patients with type 2 diabetes mellitus were managed according to guidelines. A cross-sectional study involving 517 patients with diabetes mellitus from August to October 2003 was performed. All the subjects had type 2 diabetes mellitus. 350 (67.7 percent) patients had hypertension and about 25.7 percent of them were associated with microalbuminuria. The Malay ethnic group form the majority (54.6 percent), followed by Chinese (37.7 percent) and Indian (7.4 percent). Only 11 (3.1 percent) patients with type 2 diabetes mellitus and hypertension achieved the target blood pressure of less than 130/80 mmHg. For those who had not achieved the target goal, 39.5 percent of them were not on any antihypertensive drugs. 38.6 percent were on monotherapy and only 21.8 percent were on two or more antihypertensive drugs. Metoprolol was the most commonly used antihypertensive drug (22.4 percent), followed by Nifedipine (16.2 percent) and Prazosin (13.5 percent). Only 18.3 percent of patients with type 2 diabetes mellitus and hypertension were prescribed with angiotensin converting enzyme (ACE) inhibitors and 0.3 percent with angiotensin receptor blockers. For patients with type 2 diabetes mellitus, hypertension and microalbuminuria, only 14.1 percent of them were prescribed with ACE inhibitors. A significant proportion of patients with type 2 diabetes mellitus had associated hypertension but they were not managed optimally according to guidelines. More intensive management of hypertension among patients with diabetes is essential to reduce the morbidity and mortality at primary healthcare level.

  8. Comparative risk of microalbuminuria and proteinuria in UK residents of south Asian and white European ethnic background with type 2 diabetes: a report from UKADS.

    PubMed

    Raymond, Neil T; Paul O'Hare, J; Bellary, Srikanth; Kumar, Sudhesh; Jones, Alan; Barnett, Anthony H

    2011-11-01

    This study investigated and compared the prevalence of microalbuminuria and overt proteinuria and their determinants in a cohort of UK resident patients of white European or south Asian ethnicity with type 2 diabetes mellitus. A total of 1978 patients, comprising 1486 of south Asian and 492 of white European ethnicity, in 25 general practices in Coventry and Birmingham inner city areas in England were studied in a cross-sectional study. Demographic and risk factor data were collected and presence of microalbuminuria and overt proteinuria assessed. ISRCTN 38297969. Prevalences of microalbuminuria and overt proteinuria. Urinary albumin:creatinine measurements were available for 1852 (94%) patients. The south Asian group had a lower prevalence of microalbuminuria, 19% vs. 23% and a higher prevalence of overt proteinuria, 8% vs. 3%, χ(2) = 15.85, 2df, P = 0.0004. In multiple logistic regression models, adjusted for confounding factors, significantly increased risk for the south Asian vs. white European patients for overt proteinuria was shown; OR (95% CI) 2.17 (1.05, 4.49), P = 0.0365. For microalbuminuria, an interaction effect for ethnicity and duration of diabetes suggested that risk for south Asian patients was lower in early years following diagnosis; OR for SA vs. WH at durations 0 and 1 year were 0.56 (0.37, 0.86) and 0.59 (0.39, 0.89) respectively. After 20 years' duration, OR = 1.40 (0.63, 3.08). Comparability of ethnicity defined groups; statistical methods controlled for differences between groups, but residual confounding may remain. Analyses are based on a single measure of albumin:creatinine ratio. There were significant differences between ethnicity groups in risk factor profiles and microalbuminuria and overt proteinuria outcomes. Whilst south Asian patients had no excess risk of microalbuminuria, the risk of overt proteinuria was elevated significantly, which might be explained by faster progression of renal dysfunction in patients of south Asian

  9. The relationship between serum fetuin-A, cystatin-C levels, and microalbuminuria in patients with metabolic syndrome.

    PubMed

    Huddam, Bülent; Azak, Alper; Koçak, Gülay; Bayraktar, Nilüfer; Sezer, Siren

    2013-07-01

    The metabolic syndrome, syndrome X, is a group of metabolic disorders in which insulin resistance plays a pivotal role. The MS is an important risk factor for subsequent development of type 2 diabetes and cardiovascular disease. Fetuin-A is a liver derived blood protein that acts as effective inhibitor of soft tissue calcification. Cystatin C is a useful marker in measuring glomerular filtration rate. Moreover, recently it has been suggested that cystatin C may be a potential biomarker for detecting microalbuminuria. Microalbuminuria (MA) is a strong indicator of morbidity related to cardiovascular disorders, and is currently considered a novel diagnostic criterion for MS. It has been also demonstrated that the increased serum fetuin-A levels is associated with several parameters of MS. In this study, we attempted to investigate the relationship between serum fetuin-A, cystatin-C levels and microalbuminuria in patients with MS. A total of 50 patients with MS and 25 control were included in this study. We defined MS by the NCEP criteria among nondiabetic outpatients. Patients with MS were further divided into two groups based on MA status. Overall 25 of the participants with MS did not have MA (group I), while the remaining 25 had MA (group II). None of the subjects in the healthy control group (group III) had laboratory findings supporting the presence of MA. The serum fetuin-A and cystatin-C levels were measured using ELISA. Age, distributions of sex, BP and LDL cholesterol levels were similar among all groups. BMI, Waist/hip ratio, FBG, HOMA-IR, total cholesterol, trigliserid, CRP levels were significantly higher in group I and group II compared to control. In group II, the cystatin-C and fetuin levels were higher than control. While the cystatin-C levels were higher in group II compared to group I, the fetuin levels did not different. Morever, the fetuin A and cystatin-C concentrations were positively correlated with microalbuminuria (r = 0.26, p = 0.02; r = 0

  10. The Association of a Genetic Variant in SCAF8-CNKSR3 with Diabetic Kidney Disease and Diabetic Retinopathy in a Chinese Population

    PubMed Central

    Jin, Li; Wang, Tao; Jiang, Song; Chen, Miao; Zhang, Rong; Hu, Cheng

    2017-01-01

    Background. Genome-wide association studies found rs955333 located in 6q25.2 was associated with diabetic kidney disease in multiple ethnic populations, including European Americans, African Americans, and Mexican Americans. We aimed to investigate the association between the variant rs955333 in SCAF8-CNKSR3 and DKD susceptibility in Chinese type 2 diabetes patients. Methods. The variant rs955333 was genotyped in 1884 Chinese type 2 diabetes patients. Associations of the variant rs955333 with DKD and DR susceptibility and related quantitative traits were evaluated. Results. The variant rs955333 was not associated with DKD in our samples, while subjects with genotype GG were associated with DR (P = 0.047, OR = 0.5525 [0.308,0.9911]), and it also showed association with microalbuminuria (P = 0.024, beta = −0.1812 [−0.339, −0.024]). Conclusion. Our data suggests the variant rs955333 was not associated with DKD but showed association with diabetic retinopathy in Chinese type 2 diabetes patients.

  11. Prevalence of blindness and diabetic retinopathy in northern Jordan.

    PubMed

    Rabiu, Mansur M; Al Bdour, Muawyah D; Abu Ameerh, Mohammed A; Jadoon, Muhammed Z

    2015-01-01

    To estimate the prevalence of blindness, visual impairment, diabetes, and diabetic retinopathy in north Jordan (Irbid) using the rapid assessment of avoidable blindness and diabetic retinopathy methodology. A multistage cluster random sampling technique was used to select participants for this survey. A total of 108 clusters were selected using probability proportional to size method while subjects within the clusters were selected using compact segment method. Survey teams moved from house to house in selected segments examining residents 50 years and older until 35 participants were recruited. All eligible people underwent a standardized examination protocol, which included ophthalmic examination and random blood sugar test using digital glucometers (Accu-Chek) in their homes. Diabetic retinopathy among diabetic patients was assessed through dilated fundus examination. A total of 3638 out of the 3780 eligible participants were examined. Age- and sex-adjusted prevalence of blindness, severe visual impairment, and visual impairment with available correction were 1.33% (95% confidence interval [CI] 0.87-1.73), 1.82% (95% CI 1.35-2.25), and 9.49% (95% CI 8.26-10.74), respectively, all higher in women. Untreated cataract and diabetic retinopathy were the major causes of blindness, accounting for 46.7% and 33.2% of total blindness cases, respectively. Glaucoma was the third major cause, accounting for 8.9% of cases. The prevalence of diabetes mellitus was 28.6% (95% CI 26.9-30.3) among the study population and higher in women. The prevalence of any retinopathy among diabetic patients was 48.4%. Cataract and diabetic retinopathy are the 2 major causes of blindness and visual impairment in northern Jordan. For both conditions, women are primarily affected, suggesting possible limitations to access to services. A diabetic retinopathy screening program needs to proactively create sex-sensitive awareness and provide easily accessible screening services with prompt treatment.

  12. Cost-effectiveness of early treatment for retinopathy of prematurity.

    PubMed

    Kamholz, Karen L; Cole, Cynthia H; Gray, James E; Zupancic, John A F

    2009-01-01

    The Early Treatment for Retinopathy of Prematurity trial demonstrated that peripheral retinal ablation of eyes with high-risk prethreshold retinopathy of prematurity (early treatment) is associated with improved visual outcomes at 9 months' corrected gestational age compared with treatment at threshold disease (conventional management). However, early treatment increased the frequency of laser therapy, anesthesia with intubation, treatment-related systemic complications, and the need for repeat treatments. To determine the cost-effectiveness of an early treatment strategy for retinopathy of prematurity compared with conventional management. We developed a stochastic decision analytic model to assess the incremental cost of early treatment per eye with severe visual impairment prevented. We derived resource-use and efficacy estimates from the Early Treatment for Retinopathy of Prematurity trial's published outcome data. We used a third-party payer perspective. Our primary analysis focused on outcomes from birth through 9 months' corrected gestational age. A secondary analysis used a lifetime horizon. Parameter uncertainty was quantified by using probabilistic and deterministic sensitivity analyses. The incremental cost-effectiveness of early treatment was $14,200 per eye with severe visual impairment prevented. There was a 90% probability that the cost-effectiveness of early treatment would be less than $40,000 per eye with severe visual impairment prevented and a 0.5% probability that early treatment would be cost-saving (less costly and more effective). Limiting early treatment to more severely affected eyes (eyes with "type 1 retinopathy of prematurity" as defined by the Early Treatment for Retinopathy of Prematurity trial) had a cost-effectiveness of $6,200 per eye with severe visual impairment prevented. Analyses that considered long-term costs and outcomes found that early treatment was cost-saving. Early treatment of retinopathy of prematurity is both

  13. Education and hypertension: impact on global cardiovascular risk.

    PubMed

    Di Chiara, Tiziana; Scaglione, Alessandra; Corrao, Salvatore; Argano, Christiano; Pinto, Antonio; Scaglione, Rosario

    2017-06-28

    Improving cardiovascular risk prediction continues to be a major challenge and effective prevention of cardiovascular disease. Accordingly, several studies have recently reported on the role of cardiovascular risk education. This study was designed to evaluate the impact of education on global cardiovascular risk in hypertensive patients. The study population consisted of 223 consecutive hypertensive outpatients. Their educational status was categorized according to the number of years of formal education as follows: (1) low education (less than 10 years) and (2) medium-high education (10-15 years). In both groups, cardiometabolic comorbidities, global cardiovascular risk and echocardiographic measurements were analysed. Less educated hypertensive subjects were characterized by a significantly higher prevalence of patients with metabolic syndrome (MetS) (p < .01), greater global cardiovascular risk (p < .001), and a higher consumption of antihypertensive drugs (p < .01) rather than medium-high educated hypertensive subjects. In the same subjects, a significant increase in microalbuminuria (MA) (p < .01) and a significant decrease in E/A (p < .001) ratio was found. Univariate analysis indicated that global cardiovascular risk correlated directly with waist-hip ratio, mean blood pressure, MA, left ventricular mass index, MetS and inversely with education (r = -0.45; p < .001). Education was independently (p < .001) associated with global CV risk. Our data suggest that education may be considered the best predictor of global cardiovascular risk in hypertensives and thus has to be evaluated in the strategies of hypertension and cardiovascular risk management.

  14. The Effect of Resting Heart Rate on the New Onset of Microalbuminuria in Patients With Type 2 Diabetes: A Subanalysis of the ROADMAP Study.

    PubMed

    Schmieder, Roland E; Bramlage, Peter; Haller, Hermann; Ruilope, Luis M; Böhm, Michael

    2016-04-01

    The association between resting heart rate and new-onset microalbuminuria in patients with type 2 diabetes is not clear. The objective of the current analysis was to assess the relationship between heart rate and incidence of microalbuminuria in patients with type 2 diabetes. Data from the Randomised Olmesartan and Diabetes Microalbuminuria Prevention (ROADMAP) study were retrospectively analyzed. New-onset microalbuminuria was documented and related to heart rate as recorded at baseline and last assessment, and the mean of the measurements taken during the double-blind part of the ROADMAP trial. Patients (n = 4299) had a mean age of 57.8 ± 8.7 years and 46.3% were male. Characteristics were not different between the olmesartan and the placebo groups, except for a higher systolic blood pressure (136.7 vs 135.7 mm Hg; P = 0.04) and albumin creatinine ratio (5.9 vs 5.5; P = 0.03). Increased risk of microalbuminuria was found with increasing heart rate, independent of whether baseline [highest vs lowest quartile odds ratio (OR) 1.39; 95% confidence interval (95% CI) 1.03-1.87; P = 0.032], last assessment (OR 1.71; 95% CI 1.26-2.31; P = 0.001), or mean heart rate was considered (OR: 1.77; 95% CI: 1.30-2.41; P = 0.0003). The greater risk of new-onset microalbuminuria with a high baseline heart rate was also found when data were adjusted for mean systolic blood pressure (OR: 1.35; 95% CI: 1.00-1.82; P = 0.0496; interaction P < 0.0001). Although there was no risk increase with baseline heart rate in the placebo group (P = 0.8253 for trend), microalbuminuria was less frequent in patients receiving olmesartan in the low heart rate quartiles (P = 0.002 for trend). A low heart rate reduces the risk of patients with type 2 diabetes developing microalbuminuria, independent of blood pressure. The data demonstrate potential benefits of reducing the heart rate of type 2 diabetes patients, and indicate that olmesartan could, in

  15. Automated Early Detection of Diabetic Retinopathy

    PubMed Central

    Abràmoff, Michael D.; Reinhardt, Joseph M.; Russell, Stephen R.; Folk, James C.; Mahajan, Vinit B.; Niemeijer, Meindert; Quellec, Gwénolé

    2010-01-01

    Purpose To compare the performance of automated diabetic retinopathy (DR) detection, using the algorithm that won the 2009 Retinopathy Online Challenge Competition in 2009, (‘Challenge2009’) against that of the one currently used in EyeCheck, a large computer-aided early DR detection project. Design Evaluation of diagnostic test or technology. Participants Fundus photographic sets, consisting of two fundus images from each eye, were evaluated from 16,670 patient visits of 16,670 people with diabetes who had not previously been diagnosed with DR. Methods The fundus photographic set from each visit was analyzed by a single retinal expert; 793 of the 16,770 sets were classified as containing more than minimal DR (threshold for referral). The outcomes of the two algorithmic detectors were applied separately to the dataset and compared by standard statistical measures. Main Outcome Measures The area under the Receiver Operating Characteristic curve (AUC), a measure of the sensitivity and specificity of DR detection. Results Agreement was high, and exams containing more than minimal DR were detected with an AUC of 0.839 by the ‘Eyecheck’ algorithm and an AUC of 0.821 for ‘Challenge2009’, a statistically non-significant difference (z-score 1.91). If either of the algorithms detected DR in combination, AUC for detection was 0.86, the same as the theoretically expected maximum. At 90% sensitivity, the specificity of the ‘EyeCheck’ algorithm was 47.7% and the ‘Challenge2009’ algorithm, 43.6%. Conclusions DR detection algorithms appear to be maturing, and further improvements in detection performance cannot be differentiated from best clinical practices, because the performance of competitive algorithm development has now reached the human intra-reader variability limit. Additional validation studies on larger, well-defined, but more diverse populations of patients with diabetes are urgently needed, anticipating cost-effective early detection of DR in

  16. Deep image mining for diabetic retinopathy screening.

    PubMed

    Quellec, Gwenolé; Charrière, Katia; Boudi, Yassine; Cochener, Béatrice; Lamard, Mathieu

    2017-07-01

    Deep learning is quickly becoming the leading methodology for medical image analysis. Given a large medical archive, where each image is associated with a diagnosis, efficient pathology detectors or classifiers can be trained with virtually no expert knowledge about the target pathologies. However, deep learning algorithms, including the popular ConvNets, are black boxes: little is known about the local patterns analyzed by ConvNets to make a decision at the image level. A solution is proposed in this paper to create heatmaps showing which pixels in images play a role in the image-level predictions. In other words, a ConvNet trained for image-level classification can be used to detect lesions as well. A generalization of the backpropagation method is proposed in order to train ConvNets that produce high-quality heatmaps. The proposed solution is applied to diabetic retinopathy (DR) screening in a dataset of almost 90,000 fundus photographs from the 2015 Kaggle Diabetic Retinopathy competition and a private dataset of almost 110,000 photographs (e-ophtha). For the task of detecting referable DR, very good detection performance was achieved: Az=0.954 in Kaggle's dataset and Az=0.949 in e-ophtha. Performance was also evaluated at the image level and at the lesion level in the DiaretDB1 dataset, where four types of lesions are manually segmented: microaneurysms, hemorrhages, exudates and cotton-wool spots. For the task of detecting images containing these four lesion types, the proposed detector, which was trained to detect referable DR, outperforms recent algorithms trained to detect those lesions specifically, with pixel-level supervision. At the lesion level, the proposed detector outperforms heatmap generation algorithms for ConvNets. This detector is part of the Messidor® system for mobile eye pathology screening. Because it does not rely on expert knowledge or manual segmentation for detecting relevant patterns, the proposed solution is a promising image mining

  17. Histopathological Association between Vascular Hypertensive Changes and Different Types of Glomerulopathies.

    PubMed

    Baki, Aber Halim; Soliman, Yasser; Seif, Elham Ibrahim

    2014-01-01

    The term hypertensive nephrosclerosis has traditionally been used to describe a clinical syndrome characterized by long-term essential hypertension, hypertensive retinopathy, left ventricular hypertrophy, minimal proteinuria, and progressive renal insufficiency. In the absence of renal biopsy, the diagnosis of hypertensive nephrosclerosis is one of exclusion. We retrospectively studied 735 patients who had renal biopsies at Ain Shams University Hospitals between January 2008 and Dec 2010. The prevalence of vascular hypertensive changes was studied in relation to clinical presentation and the glomerular pathology pattern. Male to female ratio was 1:1 and the mean age was 27±17 years. No vascular hypertensive changes were found in 44.5% of biopsies while mild, moderate and severe changes were found in 28%, 22% and 4.2% respectively. Malignant hypertensive changes were seen in 1.2% of biopsies. Lupus nephritis was the most common etiology representing 18.9% of all cases, followed by focal segmental glomerulosclerosis (FSGS) (13.5%), membranoproliferative glomerulonephritis (13.3%) and membranous glomerulonephritis (8.2%). Moderate to severe vascular hypertensive changes were more common in biopsies with FSGS compared to other glomerulopathies. Hypertensive nephrosclerosis as the sole cause of renal failure represented only 1.6% of cases. Significant associations were found between the degree of vascular hypertensive changes and the grade of hypertension. Patients with severe vascular hypertensive changes were significantly older and had significantly higher serum creatinine levels compared to other groups. History and grade of hypertension significantly influence the degree of vascular hypertensive changes in renal biopsy. Moderate to severe vascular hypertensive changes were more common in biopsies with FSGS compared to other pathologies. Hypertension; Nephroangiosclerosis; Renal Biopsies.

  18. Does Insulin Like Growth Factor-1 (IGF-1) Deficiency Have a “Protective” Role in the Development of Diabetic Retinopathy in Thalassamia Major Patients?

    PubMed Central

    De Sanctis, Vincenzo; Incorvaia, Carlo; Soliman, Ashraf T; Candini, Giancarlo; Pepe, Alessia; Kattamis, Christos; Soliman, Nada A.; Elsedfy, Heba; Kholy, Mohamed El

    2015-01-01

    (32.2 %) had IGF-1 levels below the 2.5th percentile of the normal values for the Italian population. The mean serum IGF-1 concentrations were significantly lower in the diabetic versus the non-diabetic TM groups (p < 0.001). DR was present in 4 (21 %) of 19 TM patients with IDDM and was associated with the main classical risk factors, namely inefficient glycemic control and duration of the disease but not hypertension. Using the scale developed by the Global Diabetic Retinopathy Group, the DR in our patients was classified as non proliferative diabetic retinopathy (NPDR). Only a few numbers of microaneurysms [1–3] were detected. Our data also confirm the strong association of IDDM in TM patients with other endocrine and non-endocrine complications. PMID:26075045

  19. Association between Urine Albumin-to-Creatinine Ratio within the Normal Range and Incident Hypertension in Men and Women

    PubMed Central

    Yadav, Dhananjay; Kang, Dae Ryong; Koh, Sang-Baek; Kim, Jang-Young

    2016-01-01

    Purpose There have been few studies on gender difference in the impact of a urine albumin-to-creatinine ratio (UACR) within the normal range on the risk of hypertension. We evaluated whether the association between the UACR below the microalbuminuria range and the incident risk of hypertension is different between men and women. Materials and Methods A total of 1173 individuals (442 men and 731 women) aged 40 to 70 years without hypertension was examined at baseline (2005–2008) and followed (2008–2011). We defined the UACR as the amount of albumin (mg/dL) divided by creatinine (g/dL) in randomly voided urine. The subjects were classified according to UACR tertile. Results During an average of 2.6 years of follow-up, 57 men (12.9%) and 66 women (9.0%) developed hypertension. In multivariable-adjusted models, the odds ratio for new-onset hypertension comparing the highest and lowest tertiles of UACR was 1.83 [95% confidence interval (CI) 0.85–3.94] in men and 2.69 (95% CI 1.27–5.73) in women. In stratified analyses by menopausal status, higher tertiles of UACR were associated with an increased risk of incident hypertension in postmenopausal women. Conclusion Higher normal UACR levels were associated with an increased risk of incident hypertension in women. The UACR could have a clinical role in predicting the development of hypertension. PMID:27593874

  20. FT011, a Novel Cardiorenal Protective Drug, Reduces Inflammation, Gliosis and Vascular Injury in Rats with Diabetic Retinopathy

    PubMed Central

    Deliyanti, Devy; Zhang, Yuan; Khong, Fay; Berka, David R.; Stapleton, David I.; Kelly, Darren J.; Wilkinson-Berka, Jennifer L.

    2015-01-01

    Diabetic retinopathy features inflammation as well as injury to glial cells and the microvasculature, which are influenced by hypertension and overactivity of the renin-angiotensin system. FT011 is an anti-inflammatory and anti-fibrotic agent that has been reported to attenuate organ damage in diabetic rats with cardiomyopathy and nephropathy. However, the potential therapeutic utility of FT011 for diabetic retinopathy has not been evaluated. We hypothesized that FT011 would attenuate retinopathy in diabetic Ren-2 rats, which exhibit hypertension due to an overactive extra-renal renin-angiotensin system. Diabetic rats were studied for 8 and 32 weeks and received intravitreal injections of FT011 (50 μM) or vehicle (0.9% NaCl). Comparisons were to age-matched controls. In the 8-week study, retinal inflammation was examined by quantitating vascular leukocyte adherence, microglial/macrophage density and the expression of inflammatory mediators. Macroglial Müller cells, which exhibit a pro-inflammatory and pro-angiogenic phenotype in diabetes, were evaluated in the 8-week study as well as in culture following exposure to hyperglycaemia and FT011 (10, 30, 100 μM) for 72 hours. In the 32-week study, severe retinal vasculopathy was examined by quantitating acellular capillaries and extracellular matrix proteins. In diabetic rats, FT011 reduced retinal leukostasis, microglial density and mRNA levels of intercellular adhesion molecule-1 (ICAM-1). In Müller cells, FT011 reduced diabetes-induced gliosis and vascular endothelial growth factor (VEGF) immunolabeling and the hyperglycaemic-induced increase in ICAM-1, monocyte chemoattractant protein-1, CCL20, cytokine-induced neutrophil chemoattractant-1, VEGF and IL-6. Late intervention with FT011 reduced acellular capillaries and the elevated mRNA levels of collagen IV and fibronectin in diabetic rats. In conclusion, the protective effects of FT011 in cardiorenal disease extend to key elements of diabetic retinopathy and

  1. Homocysteine Serum Levels in Diabetic Patients with Non Proliferative, Proliferative and without Retinopathy

    PubMed Central

    Gagliano, Caterina; Giordano, Maria; Vacante, Marco; Caraci, Filippo; Drago, Filippo; Avitabile, Teresio; Motta, Massimo

    2014-01-01

    Homocysteine has been associated with extracellular matrix changes. The diabetic retinopathy is a neurovascular complication of diabetes mellitus and it is the leading cause of vision loss among working adults worldwide. In this study, we evaluate the role of homocysteine in diabetic retinopathy analyzing the plasma levels of homocysteine in 63 diabetic type 2 patients with nonproliferative retinopathy (NPDR), 62 patients with proliferative diabetic retinopathy (PDR), 50 healthy subjects used as control group, and 75 randomly selected patients. PMID:24877066

  2. Homocysteine serum levels in diabetic patients with non proliferative, proliferative and without retinopathy.

    PubMed

    Malaguarnera, Giulia; Gagliano, Caterina; Giordano, Maria; Salomone, Salvatore; Vacante, Marco; Bucolo, Claudio; Caraci, Filippo; Reibaldi, Michele; Drago, Filippo; Avitabile, Teresio; Motta, Massimo

    2014-01-01

    Homocysteine has been associated with extracellular matrix changes. The diabetic retinopathy is a neurovascular complication of diabetes mellitus and it is the leading cause of vision loss among working adults worldwide. In this study, we evaluate the role of homocysteine in diabetic retinopathy analyzing the plasma levels of homocysteine in 63 diabetic type 2 patients with nonproliferative retinopathy (NPDR), 62 patients with proliferative diabetic retinopathy (PDR), 50 healthy subjects used as control group, and 75 randomly selected patients.

  3. Retinopathy of prematurity: Past, present and future

    PubMed Central

    Shah, Parag K; Prabhu, Vishma; Karandikar, Smita S; Ranjan, Ratnesh; Narendran, Venkatapathy; Kalpana, Narendran

    2016-01-01

    Retinopathy of prematurity (ROP) is a vasoproliferative disorder of the retina occurring principally in new born preterm infants. It is an avoidable cause of childhood blindness. With the increase in the survival of preterm babies, ROP has become the leading cause of preventable childhood blindness throughout the world. A simple screening test done within a few weeks after birth by an ophthalmologist can avoid this preventable blindness. Although screening guidelines and protocols are strictly followed in the developed nations, it lacks in developing economies like India and China, which have the highest number of preterm deliveries in the world. The burden of this blindness in these countries is set to increase tremendously in the future, if corrective steps are not taken immediately. ROP first emerged in 1940s and 1950s, when it was called retrolental fibroplasia. Several epidemics of this disease were and are still occurring in different regions of the world and since then a lot of research has been done on this disease. However, till date very few comprehensive review articles covering all the aspects of ROP are published. This review highlights the past, present and future strategies in managing this disease. It would help the pediatricians to update their current knowledge on ROP. PMID:26862500

  4. The Vitreomacular Interface in Diabetic Retinopathy

    PubMed Central

    Agarwal, Daniel; Gelman, Rachel; Prospero Ponce, Claudia; Stevenson, William; Christoforidis, John B.

    2015-01-01

    Diabetic retinopathy (DR) is a leading health concern and a major cause of blindness. DR can be complicated by scar tissue formation, macular edema, and tractional retinal detachment. Optical coherence tomography has found that patients with DR often have diffuse retinal thickening, cystoid macular edema, posterior hyaloid traction, and tractional retinal detachment. Newer imaging techniques can even detect fine tangential folds and serous macular detachment. The interplay of the vitreous and the retina in the progression of DR involves multiple chemokine and other regulatory factors including VEGF. Understanding the cells infiltrating pathologic membranes at the vitreomacular interface has opened up the possibility of new targets for pharmacotherapy. Vitrectomies for DR remain a vital tool to help relieve tension on the macula by removing membranes, improving edema absorption, and eliminating the scaffold for new membrane formation. Newer treatments such as triamcinolone acetonide and VEGF inhibitors have become essential as a rapid way to control DR at the vitreomacular interface, improve macular edema, and reduce retinal neovascularization. These treatments alone, and in conjunction with PRP, help to prevent worsening of the VMI in patients with DR. PMID:26425349

  5. Pathophysiology and treatment of diabetic retinopathy.

    PubMed

    Bandello, Francesco; Lattanzio, Rosangela; Zucchiatti, Ilaria; Del Turco, Claudia

    2013-02-01

    In the past years, the management of diabetic retinopathy (DR) relied primarily on a good systemic control of diabetes mellitus, and as soon as the severity of the vascular lesions required further treatment, laser photocoagulation or vitreoretinal surgery was done to the patient. Currently, even if the intensive metabolic control is still mandatory, a variety of different clinical strategies could be offered to the patient. The recent advances in understanding the complex pathophysiology of DR allowed the physician to identify many cell types involved in the pathogenesis of DR and thus to develop new treatment approaches. Vasoactive and proinflammatory molecules, such as vascular endothelial growth factor (VEGF), play a key role in this multifactorial disease. Current properly designed trials, evaluating agents targeting VEGF or other mediators, showed benefits in the management of DR, especially when metabolic control is lacking. Other agents, directing to the processes of vasopermeability and angiogenesis, are under investigations, giving more hope in the future management of this still sight-threatening disease.

  6. The neural retina in retinopathy of prematurity.

    PubMed

    Hansen, Ronald M; Moskowitz, Anne; Akula, James D; Fulton, Anne B

    2017-01-01

    Retinopathy of prematurity (ROP) is a neurovascular disease that affects prematurely born infants and is known to have significant long term effects on vision. We conducted the studies described herein not only to learn more about vision but also about the pathogenesis of ROP. The coincidence of ROP onset and rapid developmental elongation of the rod photoreceptor outer segments motivated us to consider the role of the rods in this disease. We used noninvasive electroretinographic (ERG), psychophysical, and retinal imaging procedures to study the function and structure of the neurosensory retina. Rod photoreceptor and post-receptor responses are significantly altered years after the preterm days during which ROP is an active disease. The alterations include persistent rod dysfunction, and evidence of compensatory remodeling of the post-receptor retina is found in ERG responses to full-field stimuli and in psychophysical thresholds that probe small retinal regions. In the central retina, both Mild and Severe ROP delay maturation of parafoveal scotopic thresholds and are associated with attenuation of cone mediated multifocal ERG responses, significant thickening of post-receptor retinal laminae, and dysmorphic cone photoreceptors. These results have implications for vision and control of eye growth and refractive development and suggest future research directions. These results also lead to a proposal for noninvasive management using light that may add to the currently invasive therapeutic armamentarium against ROP.

  7. The neurovascular retina in retinopathy of prematurity.

    PubMed

    Fulton, Anne B; Hansen, Ronald M; Moskowitz, Anne; Akula, James D

    2009-11-01

    The continuing worldwide epidemic of retinopathy of prematurity (ROP), a leading cause of childhood visual impairment, strongly motivates further research into mechanisms of the disease. Although the hallmark of ROP is abnormal retinal vasculature, a growing body of evidence supports a critical role for the neural retina in the ROP disease process. The age of onset of ROP coincides with the rapid developmental increase in rod photoreceptor outer segment length and rhodopsin content of the retina with escalation of energy demands. Using a combination of non-invasive electroretinographic (ERG), psychophysical, and image analysis procedures, the neural retina and its vasculature have been studied in prematurely born human subjects, both with and without ROP, and in rats that model the key vascular and neural parameters found in human ROP subjects. These data are compared to comprehensive numeric summaries of the neural and vascular features in normally developing human and rat retina. In rats, biochemical, anatomical, and molecular biological investigations are paired with the non-invasive assessments. ROP, even if mild, primarily and persistently alters the structure and function of photoreceptors. Post-receptor neurons and retinal vasculature, which are intimately related, are also affected by ROP; conspicuous neurovascular abnormalities disappear, but subtle structural anomalies and functional deficits may persist years after clinical ROP resolves. The data from human subjects and rat models identify photoreceptor and post-receptor targets for interventions that promise improved outcomes for children at risk for ROP.

  8. Understanding retinopathy of prematurity: update on pathogenesis.

    PubMed

    Rivera, José Carlos; Sapieha, Przemyslaw; Joyal, Jean-Sébastien; Duhamel, François; Shao, Zhuo; Sitaras, Nicholas; Picard, Emilie; Zhou, Ellen; Lachapelle, Pierre; Chemtob, Sylvain

    2011-01-01

    Retinopathy of prematurity (ROP), an ocular disease characterized by the onset of vascular abnormalities in the developing retina, is the major cause of visual impairment and blindness in premature neonates. ROP is a complex condition in which various factors participate at different stages of the disease leading to microvascular degeneration followed by neovascularization, which in turn predisposes to retinal detachment. Current ablative therapies (cryotherapy and laser photocoagulation) used in the clinic for the treatment of ROP have limitations and patients can still have long-term effects even after successful treatment. New treatment modalities are still emerging. The most promising are the therapies directed against VEGF; more recently the use of preventive dietary supplementation with ω-3 polyunsaturated fatty acid may also be promising. Other than pharmacologic and nutritional approaches, cell-based strategies for vascular repair are likely to arise from advances in regenerative medicine using stem cells. In addition to all of these, a greater understanding of other factors involved in regulating pathologic retinal angiogenesis continues to emerge, suggesting potential targets for therapeutic approaches. This review summarizes an update on the current state of knowledge on ROP from our and other laboratories, with particular focus on the role of nitro-oxidative stress and notably trans-arachidonic acids in microvascular degeneration, semaphorin 3 operating as vasorepulsive molecules in the avascular hypoxic retina and in turn impairing revascularization, succinate and its receptor GPR91 in neuron-mediated retinal neovascularization, and ω-3 lipids as modulators of preretinal neovascularization.

  9. Retinal Imaging Techniques for Diabetic Retinopathy Screening

    PubMed Central

    Goh, James Kang Hao; Cheung, Carol Y.; Sim, Shaun Sebastian; Tan, Pok Chien; Tan, Gavin Siew Wei; Wong, Tien Yin

    2016-01-01

    Due to the increasing prevalence of diabetes mellitus, demand for diabetic retinopathy (DR) screening platforms is steeply increasing. Early detection and treatment of DR are key public health interventions that can greatly reduce the likelihood of vision loss. Current DR screening programs typically employ retinal fundus photography, which relies on skilled readers for manual DR assessment. However, this is labor-intensive and suffers from inconsistency across sites. Hence, there has been a recent proliferation of automated retinal image analysis software that may potentially alleviate this burden cost-effectively. Furthermore, current screening programs based on 2-dimensional fundus photography do not effectively screen for diabetic macular edema (DME). Optical coherence tomography is becoming increasingly recognized as the reference standard for DME assessment and can potentially provide a cost-effective solution for improving DME detection in large-scale DR screening programs. Current screening techniques are also unable to image the peripheral retina and require pharmacological pupil dilation; ultra-widefield imaging and confocal scanning laser ophthalmoscopy, which address these drawbacks, possess great potential. In this review, we summarize the current DR screening methods using various retinal imaging techniques, and also outline future possibilities. Advances in retinal imaging techniques can potentially transform the management of patients with diabetes, providing savings in health care costs and resources. PMID:26830491

  10. Prolactin and vasoinhibins: Endogenous players in diabetic retinopathy.

    PubMed

    Triebel, Jakob; Macotela, Yazmín; de la Escalera, Gonzalo Martínez; Clapp, Carmen

    2011-10-01

    Diabetic retinopathy is a disease of the retinal microvasculature that develops as a complication of diabetes mellitus and constitutes a major cause of blindness in adults of all ages. Diabetic retinopathy is characterized by the loss of capillary cells leading to increased vasopermeability, ischemia, and hypoxia that trigger the excessive formation of new blood vessels in the retina. The influence of the pituitary gland in the pathophysiology of diabetic retinopathy was recognized nearly six decades ago, but the contribution of pituitary hormones to this disease remains unclear. Recent studies have shown that the pituitary hormone prolactin is proteolytically cleaved to vasoinhibins, a family of peptides with potent antivasopermeability, vasoconstrictive, and antiangiogenic actions that can protect the eye against the deleterious effects of the diabetic state. In this review, we summarize what is known about the changes in the circulating levels of prolactin and vasoinhibins during diabetes and diabetic retinopathy as well as the implications of these changes for the development and progression of the disease with particular attention to hyperprolactinemia in pregnancy and postpartum. We discuss the effects of prolactin and vasoinhibins that may impact diabetic retinopathy and suggest these hormones as important targets for therapeutic interventions. Copyright © 2011 Wiley Periodicals, Inc.

  11. [Retinal image analysis to detect lesions associated with diabetic retinopathy].

    PubMed

    Sánchez Gutiérrez, C I; López Gálvez, M I; Hornero Sánchez, R; Poza Crespo, J

    2004-12-01

    Diabetic retinopathy is a leading cause of vision loss in developed countries. Regular diabetic retinal eye screenings are needed to detect early signs of retinopathy, so that appropriate treatments can be rendered to prevent blindness. Digital imaging is becoming available as a means of screening for diabetic retinopathy. However, with the large number of patients undergoing screenings, medical professionals require a tremendous amount of time and effort in order to analyse and diagnose the fundus photographs. Our aim is to develop an automatic algorithm using digital image analysis for detecting these early lesions from retinal images. An automatic method to detect hard exudates, a lesion associated with diabetic retinopathy, is proposed. The algorithm is based on their colour, using a statistical classification, and their sharp edges, applying an edge detector, to localise them. A sensitivity of 79.62% with a mean number of 3 false positives per image is obtained in a database of 20 retinal images with variable colour, brightness and quality. It can also be seen that the number of the false negative cases increases when the hard exudates were very close to the vessel tree. The long term goal of the project is to automate the screening for diabetic retinopathy with retinal images. We have described the preliminary development of a tool to provide automatic analysis of digital fundus photographs to localise hard exudates. Future work will address the issue of improving the obtained results and also will focus on detecting other lesions.

  12. Solar retinopathy in a hospital-based primary care clinic.

    PubMed

    Stokkermans, T J; Dunbar, M T

    1998-10-01

    Most reports of solar retinopathy describe epidemics of patients who go to the eye doctor after viewing a solar eclipse. Rarely is it encountered by the primary eye care provider during a routine eye examination. For 26 months, patients who went to the primary care eye clinic and found to have macular lesions consistent with solar retinopathy were identified from the total clinic population. These patients were documented in a coded log and fundus photographs were obtained (when possible). Twenty-six eyes of twenty patients (0.14% incidence) were determined to have macular lesions consistent with solar retinopathy. Visual acuity was 20/25 or better in 100% of the patients and 85% were 20/20. Patients were predominantly men (75%) of middle age (average age, 43 years; SD, 11 years) with a history relevant for solar retinopathy (80%)--consisting of sungazing, 60%; looking at welding light without eye protection, 15%; substance abuse, 15%; and psychiatric condition, 5%. Forty percent had solar lesions in both eyes. Amsler grid testing revealed a defect in only 20%, and macular threshold visual-field testing was normal in all the eyes tested. This is the first report to characterize solar retinopathy in a primary eye care population. Management includes correct differentiation from other macular disorders, acquisition of a careful detailed history, and provision of patient education regarding the dangers of sungazing.

  13. Diaretinopathy database –A Gene database for diabetic retinopathy

    PubMed Central

    Vidhya, Gopalakrishnan; Anusha, Bhaskar

    2014-01-01

    Diabetic retinopathy, is a microvascular complication of diabetes mellitus and is a major cause of adult blindness. Despite advances in diagnosis and treatment the pathogenesis of diabetic retinopathy is not well understood. Results from epidemiological studies of diabetic patients suggest that there are familial predispositions to diabetes and to diabetic retinopathy. Therefore the main purpose of this database is to help both scientists and doctors in studying the candidate genes responsible for causing diabetic retinopathy. For each candidate gene official symbol, chromosome map, number of exons, GT-AG introns, motif, polymorphic variation and 3D structure are given respectively. In addition to molecular class and function of these genes, this database also provides links to download the corresponding nucleotide and amino acid sequences in FASTA format which may be further used for computational approaches. Therefore this database will increase the understanding of the genetics underlying the development or progression of diabetic retinopathy and will have an impact on future diagnostic, prevention and intervention strategies. Availability The database is freely available at http: diaretinopathydatabase.com PMID:24966527

  14. Screening Intervals for Diabetic Retinopathy and Implications for Care.

    PubMed

    Scanlon, Peter H

    2017-09-05

    The purpose of this study is to review the evidence that lower risk groups who could safely be screened less frequently for sight-threatening diabetic retinopathy (DR) than annually. Data have demonstrated that people with no DR in either eye are at a low risk of progression to sight-threatening DR over a 2-year period (event rate 4.8 per 1000 person years), irrespective of whether the screening method is one-field non-mydriatic or two-field mydriatic digital photography. Low risk has been defined as no retinopathy on two consecutive screening episodes or no retinopathy on one screening episode combined with risk factor data. The risk of an extension to 2 years is less than 5 per 1000 person years in a population with a national screening programme, and the general standard of diabetes care is relatively good, whether low risk is defined as no retinopathy on two consecutive screening episodes or no retinopathy on one screening episode combined with other risk factor data. The definition used in different populations is likely to depend on the availability of data.

  15. The growing epidemic of hypertension among children and adolescents: a challenging road ahead.

    PubMed

    Assadi, Farahnak

    2012-10-01

    Currently, it is clear that primary hypertension begins in childhood and that it contributes to the early development of chronic kidney disease (CKD). Hypertension also increases the risk of cardiovascular morbidity and mortality, and that risk rises as blood pressure levels escalate. As among adult patients, overweight and obesity rates are on the rise among children and adolescents with primary hypertension and can develop target organ damage including left ventricular hypertrophy. An elevated level of C-reactive protein (CRP) and microalbuminuria are early manifestations of cardiovascular disease and CKD in hypertensive patients. Lifestyle interventions are recommended for all children with hypertension. Pharmacologic therapy should be added for symptomatic children, those with stage 2 hypertension, and children with prehypertension and stage 1 hypertension who exhibit an insufficient response to lifestyle modifications. Although the recommendations for choice of drugs generally are similar for children and adults, dosages for children should be lower, based on weight, and adjusted very carefully. Medications that are effective and safe for children and adolescents include thiazide diuretics, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, beta-blockers, and calcium channel-blockers. Hypertension is not being detected early enough for initiation of a treatment regimen to reduce death and disability. Initiatives should be undertaken to make health care providers and the general population more aware of the seriousness of hypertension in children and adolescents. This review focuses on the principles underlying the importance of a team approach for hypertension control, especially one that incorporates increased data sharing using enhanced health information technology for early detection and intervention.

  16. Radiation retinopathy as an experimental model for ischemic proliferative retinopathy and rubeosis iridis

    SciTech Connect

    Irvine, A.R.; Wood, I.S.

    1987-06-15

    We produced radiation retinopathy in capuchin monkeys and studied them with fluorescein angiography and light and electron microscopy. The animals were followed up from ten days to 3 1/2 years after radiation in order to determine whether this could provide an experimental model for other chronic ischemic-proliferative retinopathies, such as diabetes. The first change detected after radiation was the focal loss of capillary endothelial cells and pericytes. As the areas of acellular capillaries became confluent, cotton-wool spots became visible ophthalmoscopically. These increased in number and then faded away, leaving large areas of retinal capillary perfusion. Histologic studies showed occlusion first of the deeper, smaller retinal vessels and then gradually of the larger vessels. Intraretinal neovascularization as well as apparent recanalization then developed, but no new vessels extended through the internal limiting lamina into the vitreous. Rubeosis iridis with neovascular glaucoma developed 2 1/2 to 3 1/2 years postirradiation, and vitreous aspirate demonstrated a high level of angiogenic factor.

  17. Retinopathy in youth with type 2 diabetes participating in the TODAY clinical trial

    USDA-ARS?s Scientific Manuscript database

    The objective of this study was to determine the prevalence of retinopathy in 517 youth with type 2 diabetes of 2–8 years duration enrolled in the TODAY study. Retinal photographs were graded centrally for retinopathy using established standards. Retinopathy was identified in 13.7% of subjects. Prev...

  18. Resistant hypertension.

    PubMed

    Armario, P; Oliveras, A; de la Sierra, A

    2013-11-01

    A 53 year old woman with hypercholesterolemia treated with statins, with no history of cardiovascular disease, was referred to the Hypertension and Vascular Risk Unit for management of hypertension resistant to 4 antihypertensive agents at full doses. The patient had obesity, with a body mass index of 36.3kg/m(2) and office blood pressure 162/102mm Hg. Physical examination showed no data of interest. glucose 120mg/dl, glycated Hb: 6.4%, albuminuria 68mg/g, kidney function and study of the renin angiotensin system and other biochemical parameters were normal. Echocardiography: left ventricular mass, 131g/m(2) (normal, <110g/m(2)). True resistant hypertension was confirmed by ambulatory monitoring of blood pressure during 24h (153/89mm Hg). Spironolactone treatment (25mg/day) was added and was well tolerated, with no change in renal function and kaliemia within normal (4.1mmol/l) following the treatment. After 8 weeks, blood pressure was well controlled: office blood pressure 132/86mm Hg and 24h-ambulatory blood pressure: 128/79mm Hg. Copyright © 2013 Elsevier España, S.L. All rights reserved.

  19. Lipoprotein(a) predicts the development of diabetic retinopathy in people with type 2 diabetes mellitus.

    PubMed

    Yun, Jae-Seung; Lim, Tae-Seok; Cha, Seon-Ah; Ahn, Yu-Bae; Song, Ki-Ho; Choi, Jin A; Kwon, Jinwoo; Jee, Donghyun; Cho, Yang Kyung; Park, Yong-Moon; Ko, Seung-Hyun

    2016-01-01

    Lipoprotein(a) [Lp(a)] has mainly been considered to be a predictor of the incidence of cardiovascular disease. In addition, previous studies have shown potential linkage between Lp(a) and diabetic microvascular complications. We investigated the incidence and risk factors for the development of diabetic retinopathy (DR) in patients with type 2 diabetes. A total of 787 patients with type 2 diabetes without DR were consecutively enrolled and followed up prospectively. Retinopathy evaluation was annually performed by ophthalmologists. The main outcome was new onset of DR. The median follow-up time was 11.1 years. Patients in the DR group had a longer duration of diabetes (P < .001), higher baseline HbA1c (P < .001), higher albuminuria level (P = .033), and higher level of Lp(a) (P = .005). After adjusting for sex, age, diabetes duration, presence of hypertension, renal function, LDL cholesterol, mean HbA1c, and medications, the development of DR was significantly associated with the serum Lp(a) level (HR 1.57, 95% confidence interval [1.11-2.24]; P = .012, comparing the 4th vs 1st quartile of Lp(a)). The patient group with the highest quartile range of Lp(a) and mean HbA1c levels ≥7.0% had an HR of 5.09 (95% confidence interval [2.63-9.84]; P < .001) for developing DR compared with patients with lower levels of both factors. In this prospective cohort study, we demonstrated that the DR was independently associated with the serum Lp(a) level in patients with type 2 diabetes. Copyright © 2016 National Lipid Association. Published by Elsevier Inc. All rights reserved.

  20. Pulmonary Hypertension

    PubMed Central

    Kim, John S.; McSweeney, Julia; Lee, Joanne; Ivy, Dunbar

    2015-01-01

    Objective Review the pharmacologic treatment options for pulmonary arterial hypertension (PAH) in the cardiac intensive care setting and summarize the most-recent literature supporting these therapies. Data Sources and Study Selection Literature search for prospective studies, retrospective analyses, and case reports evaluating the safety and efficacy of PAH therapies. Data Extraction Mechanisms of action and pharmacokinetics, treatment recommendations, safety considerations, and outcomes for specific medical therapies. Data Synthesis Specific targeted therapies developed for the treatment of adult patients with PAH have been applied for the benefit of children with PAH. With the exception of inhaled nitric oxide, there are no PAH medications approved for children in the US by the FDA. Unfortunately, data on treatment strategies in children with PAH are limited by the small number of randomized controlled clinical trials evaluating the safety and efficacy of specific treatments. The treatment options for PAH in children focus on endothelial-based pathways. Calcium channel blockers are recommended for use in a very small, select group of children who are responsive to vasoreactivity testing at cardiac catheterization. Phosphodiesterase type 5 inhibitor therapy is the most-commonly recommended oral treatment option in children with PAH. Prostacyclins provide adjunctive therapy for the treatment of PAH as infusions (intravenous and subcutaneous) and inhalation agents. Inhaled nitric oxide is the first line vasodilator therapy in persistent pulmonary hypertension of the newborn, and is commonly used in the treatment of PAH in the Intensive Care Unit (ICU). Endothelin receptor antagonists have been shown to improve exercise tolerance and survival in adult patients with PAH. Soluble Guanylate Cyclase Stimulators are the first drug class to be FDA approved for the treatment of chronic thromboembolic pulmonary hypertension. Conclusions Literature and data supporting the

  1. Canthaxanthin Retinopathy with Visual Loss: A Case Report and Review

    PubMed Central

    Beaulieu, Robert A.; Warwar, Ronald E.; Buerk, Bruce M.

    2013-01-01

    Canthaxanthin is a naturally occurring chemical, which is most commonly utilized as a colorant for food and dyes or a skin bronzing agent. Its most prevalent impact on human health is canthaxanthin retinopathy, which appears as birefringent, yellow to red crystals surrounding the macula. This occurs with increasing, dose-dependent exposure. Generally, patients remain asymptomatic and findings may only be evident on funduscopic examination. Cessation of canthaxanthin ingestion appears to reverse the retinopathy, but the time until crystal disappearance is variable. Despite a usually favorable outcome, long-standing visual changes may occur. We report a case of an 84-year-old woman with significant visual loss secondary to canthaxanthin retinopathy that ultimately improved upon cessation of the drug. PMID:24288637

  2. Cancer associated retinopathy (CAR): An autoimmune-mediated paraneoplastic syndrome.

    PubMed

    Khan, Nadia; Huang, John J; Foster, C Stephen

    2006-01-01

    Cancer associated retinopathy (CAR) is an uncommon paraneoplastic retinopathy in which antibodies are directed against retinal antigens. Vision loss is associated with abnormal ERG findings. Few case reports and lack of controlled clinical trials make management of this syndrome especially challenging for the clinician. Herein, we describe the clinical, histopathologic and electrophysiologic features of CAR, along with a summary of previously employed management options. Cancer associated retinopathy syndrome has been recognized as a paraneoplastic disorder, most commonly associated with small cell lung cancer, in which cross-reacting autoantibodies against retinal antigen cause retinal dysfunction. Bilateral vision loss as a result of both rod and cone dysfunction in CAR may occur over a period of months, and visual symptoms may precede diagnosis of the systemic malignancy. The heterogeneity in antigens that have been identified as targets of antibody-mediated retinal damage perhaps help to explain the complexity of symptoms and the treatment challenges posed by patients with CAR.

  3. Radiation retinopathy after orbital irradiation for Graves' ophthalmopathy

    SciTech Connect

    Kinyoun, J.L.; Kalina, R.E.; Brower, S.A.; Mills, R.P.; Johnson, R.H.

    1984-10-01

    Recent reports indicate that orbital irradiation for Graves' ophthalmopathy is sometimes beneficial, particularly for dysthyroid optic neuropathy, and is not associated with serious complications. We are aware, however, of four patients who were found to have radiation retinopathy after orbital irradiation for Grave's ophthalmopathy. All four patients have decreased central acuity, and three of the four are legally blind in one or both eyes. Computer reconstruction of the dosimetry, based on computed tomography and beam profiles, shows that errors in dosage calculations and radiotherapy technique probably account for the radiation retinopathy in three of the four patients. Radiotherapy for Graves' ophthalmopathy should be administered only by competent radiotherapists who are experienced in the treatment of this disease. Similar errors in dosage calculations and treatment techniques may account for other reports of radiation retinopathy after reportedly safe dosages.

  4. Purtscher-like retinopathy preceding acute renal failure.

    PubMed

    Sánchez Vicente, J L; Castilla Martino, M; Contreras Díaz, M; Rueda Rueda, T; Molina Socola, F E; Muñoz Morales, A; López Herrero, F; Moruno Rodríguez, A; Vizuete Rodríguez, L; Martínez Borrego, A

    2017-07-28

    The case is reported of a 61 year-old woman with Purtscher-like retinopathy associated with acute renal failure. Ophthalmic examination, fluorescein-angiography, and optical coherence tomography were consistent with Purtscher-like retinopathy. Ophthalmic symptoms and signs preceded renal failure. Pancreatitis and other systemic diseases were ruled out. The patient developed a neovascular glaucoma. Purtscher-like retinopathy rarely precedes the associated systemic illness. Early diagnosis based on ophthalmic symptoms may help in the recognition and treatment of the disease, and prevent later complications. Copyright © 2017 Sociedad Española de Oftalmología. Publicado por Elsevier España, S.L.U. All rights reserved.

  5. Ultra-wide-field imaging in diabetic retinopathy; an overview.

    PubMed

    Ghasemi Falavarjani, Khalil; Wang, Kang; Khadamy, Joobin; Sadda, Srinivas R

    2016-06-01

    To present an overview on ultra-wide-field imaging in diabetic retinopathy. A comprehensive search of the pubmed database was performed using the search terms of "ultra-wide-field imaging", "ultra-wide-field fluorescein angiography" and "diabetic retinopathy". The relevant original articles were reviewed. New advances in ultra-wide-field imaging allow for precise measurements of the peripheral retinal lesions. A consistent finding amongst these articles was that ultra-wide-field imaging improved detection of peripheral lesion. There was discordance among the studies, however, on the correlation between peripheral diabetic lesions and diabetic macular edema. Visualization of the peripheral retina using ultra-wide-field imaging improves diagnosis and classification of diabetic retinopathy. Additional studies are needed to better define the association of peripheral diabetic lesions with diabetic macular edema.

  6. Ischemic retinopathy associated with Crohn’s disease

    PubMed Central

    Siqueira, Rubens Camargo; Kaiser Junior, Roberto Luiz; Ruiz, Lilian Piron; Ruiz, Milton Arthur

    2016-01-01

    Purpose To report a case of a patient with ischemic retinopathy associated with Crohn’s disease. Case report This report presents a case of a 28-year-old female patient with Crohn’s disease and sudden decrease of visual acuity in the right eye. Fluorescein angiography, optical coherence tomography, and multifocal electroretinography confirmed the clinical features of ischemic retinopathy. After systemic corticosteroid treatment, the patient developed epiretinal membrane without significant improvement in visual acuity. Discussion The patient presented with ischemic retinopathy associated with Crohn’s disease with deficiency of central visual acuity. Periodic examination by a retina specialist is recommended for patients being treated for Crohn’s disease. PMID:27524921

  7. Comparative microRNA profiling in relation to urinary albumin excretion in newly diagnosed hypertensive patients.

    PubMed

    Parthenakis, F I; Marketou, M E; Kontaraki, J E; Maragoudakis, F; Maragkoudakis, S; Nakou, H; Roufas, K; Patrianakos, A; Chlouverakis, G; Malliaraki, N; Vardas, P E

    2016-11-01

    Microalbuminuria is an established early marker of endothelial dysfunction and damage. MicroRNAs (miRNAs) are emerging as essential modulators of cardiovascular physiology and disease. In the present study, we sought an association between the differential expression of related miRNAs in the peripheral blood mononuclear cells of untreated patients with newly diagnosed essential hypertension and the levels of urinary albumin excretion. We assessed the expression of the miRNAs miRNA-1, miRNA-133a, miRNA-26b, miRNA-208b, miRNA-499 and miRNA-21 in consecutive subjects with untreated newly diagnosed essential hypertension (aged 62.5±9.7 years) and with no indications of other organic heart disease. MiRNA expression levels in peripheral blood mononuclear cells were quantified by real-time reverse transcription-polymerase chain reaction. The prevalence of microalbuminuria was 9.8%. miRNA-208b and miRNA-133a were independently correlated with 24-h urinary albumin excretion. More specifically, a strong association was found between the gene expression levels of miRNA-208b in our patients' peripheral blood cells and urinary albumin (r=0.72, P<0.001). A similar association was found for miRNA-133a (r=0.372, P<0.001). In conclusion, miRNA-208b and miRNA-133a show distinct profiling in peripheral blood cells isolated from untreated patients with recently diagnosed essential hypertension. Their gene expression levels reveal a strong correlation with urinary albumin excretion levels. Our findings provide new perspectives on the development of a new generation of biomarkers for the better monitoring of end-organ damage in hypertension.

  8. The Value of Serum Prolidase Activity in Progression of Microalbuminuria in Patients With Type 2 Diabetes Mellitus.

    PubMed

    Sabuncu, Tevfik; Boduroglu, Omer; Eren, Mehmet Ali; Torun, Ayse Nur; Aksoy, Nurten

    2016-09-01

    Prolidase is a cytosolic exopeptidase that plays a pivotal role in collagen turnover. Diabetic nephropathy (DN) is associated with structural changes in glomerular basement membrane accompanied with increased amounts of collagen. Prolidase is known to be abundant in kidney and collagen accumulation is increased in DN, so we aimed to determine the value of serum prolidase activity (SPA) in predicting the progression of nephropathy in type 2 diabetes mellitus (DM). Thirty type 2 DM patients having microalbuminuria (microalbuminuric group), 30 type 2 DM patients without albuminuria (normoalbuminuric group), and 28 healthy controls (control group) were enrolled. Study groups had similar age, sex distribution, and body mass index (BMI). Metabolic parameters, SPA and urinary microalbumin were determined. SPA was significantly higher in microalbuminuric group when compared with normoalbuminuric and control groups (P = 0.05 and P < 0.001, respectively). Triglyceride levels were significantly higher and high density lipoprotein cholesterol (HDL-C) levels were significantly lower in microalbuminuric group compared to control group (Both P < 0.05). SPA showed a negative correlation with HDL-C level and a positive correlation with urinary albumin excretion (r = -0.219, P < 0.05 and r = 0.39, P < 0.001 respectively). In regression analysis, albumin excretion was the sole parameter influencing SPA. SPA appears to be higher in type 2 DM patients having microalbuminuria compared to patients without microalbuminuria and healthy controls. The pathophysiological role and the significance of SPA in predicting DN need to be further evaluated. © 2015 Wiley Periodicals, Inc.

  9. Utilities associated with diabetic retinopathy: results from a Canadian sample.

    PubMed

    Sharma, S; Oliver-Fernandez, A; Bakal, J; Hollands, H; Brown, G C; Brown, M M

    2003-03-01

    To report patient based utilities, using the time trade-off technique, associated with visual loss secondary to diabetic retinopathy in a sample of Canadian patients. In addition, to compare these utility values with a sample collected in a similar manner in a tertiary care practice in the United States. A cross sectional study of eligible patients with diabetic retinopathy presenting to a tertiary facility was performed. Demographic and clinical variables (including Snellen visual acuity), and utilities were collected both through chart review and standardised interviews with diabetic patients. 221 patients with diabetic retinopathy were eligible for this study and completed the interview. The mean age was 63.5 (SD 12.5) years, and 48.4% were female. Over 35% of the sample had visual acuity in the affected eye of 6/60 or worse. The mean utility for the sample was 0.79 (SD 0.23). The mean utility from this sample did not differ significantly from that obtained from a series of patients with diabetic retinopathy who were referred to a tertiary facility in the United States (mean 0.77, SD 0.21, p=0.313). Our cross border comparison had a power of 95% to detect a difference in utility of 0.1 between the two groups. On average, Canadian patients with diabetic retinopathy were willing to trade off over 20% of their remaining lifespan in order to eliminate their ocular disease. The mean utility obtained from our sample of Canadian patients with diabetic retinopathy was not statistically different from that obtained from a similar sample of American patients.

  10. Utilities associated with diabetic retinopathy: results from a Canadian sample

    PubMed Central

    Sharma, S; Oliver-Fernandez, A; Bakal, J; Hollands, H; Brown, G C; Brown, M M

    2003-01-01

    Background/aims: To report patient based utilities, using the time trade-off technique, associated with visual loss secondary to diabetic retinopathy in a sample of Canadian patients. In addition, to compare these utility values with a sample collected in a similar manner in a tertiary care practice in the United States. Methods: A cross sectional study of eligible patients with diabetic retinopathy presenting to a tertiary facility was performed. Demographic and clinical variables (including Snellen visual acuity), and utilities were collected both through chart review and standardised interviews with diabetic patients. Results: 221 patients with diabetic retinopathy were eligible for this study and completed the interview. The mean age was 63.5 (SD 12.5) years, and 48.4% were female. Over 35% of the sample had visual acuity in the affected eye of 6/60 or worse. The mean utility for the sample was 0.79 (SD 0.23). The mean utility from this sample did not differ significantly from that obtained from a series of patients with diabetic retinopathy who were referred to a tertiary facility in the United States (mean 0.77, SD 0.21, p=0.313). Our cross border comparison had a power of 95% to detect a difference in utility of 0.1 between the two groups. Conclusion: On average, Canadian patients with diabetic retinopathy were willing to trade off over 20% of their remaining lifespan in order to eliminate their ocular disease. The mean utility obtained from our sample of Canadian patients with diabetic retinopathy was not statistically different from that obtained from a similar sample of American patients. PMID:12598432

  11. Perceptions of diabetic retinopathy and screening procedures among diabetic people.

    PubMed

    Trento, M; Bajardi, M; Borgo, E; Passera, P; Maurino, M; Gibbins, R; Owens, D R; Cavallo, F; Porta, M

    2002-10-01

    To assess how diabetic patients perceive retinopathy, screening for sight-threatening lesions and their own role in preventing blindness. A questionnaire was administered to 258 consecutive patients after screening for retinopathy, according to the European Field Guide-Book procedure, in Turin (n = 130) and Wales (n = 128, W). All Welsh patients and 70 in Turin (T1) were on standard diabetes care at their clinic or general practitioner, whereas 60 in Turin (T2) were on permanent group education. According to 65%, 84% and 100% of patients in W, T1 and T2, respectively, diabetes may damage the eyes. Retinopathy had been heard of by 48% (W), 67% (T1) and 100% (T2). In T2, 82% of patients could give a meaningful description of retinopathy but only 17% could use correctly the word 'retina'. In W and T1, 16% and 19% could describe retinopathy but none could describe the retina. In W and T1, 47% and 57% believed they could not help with eye care, whereas 78% in T2 replied that they should control diabetes and 20% that eyes should be checked regularly. Regarding reasons for screening, 100% of patients in T2 answered 'prevention and checks', against 61% in T1 and only 9% in W. In T1 and W, 33% and 37% did not know why they were being screened. Patients' health perceptions and internal control mechanisms may be insufficiently developed for optimal participation in retinopathy screening. Diabetes care by long-term group education may address this problem.

  12. [Pro-inflammatory serum cytokines in diabetic retinopathy].

    PubMed

    Hernández-Da Mota, Sergio Eustolio; Soto-Bahena, José Juan; Viveros-Sandoval, Martha Eva; Cardiel-Ríos, Mario

    2015-01-01

    Pro-inflammatory cytokines play an important role in diabetic retinopathy. There is conflicting evidence about their serum elevation in this condition and that they also may be possible serum inflammatory biomarkers of diabetic retinopathy. To evaluate the presence of serum pro-inflammatory cytokines and acute phase reactants in the serum of patients with and without diabetic retinopathy. Comparative case series with 36 patients divided into three groups were included: 12 patients with diabetes mellitus and diabetic retinopathy (group 1), 12 diabetic patients without diabetic retinopathy (group 2), and 12 healthy patients as a control group. Serum levels of the following pro-inflammatory cytokines were measured in all patients: TNF-α, IL-1β and IL-6. Pro-inflammatory biomarkers measurements were also performed, such as erythrocyte sedimentation rate and C-reactive protein. The levels of TNF-α and IL-6 were higher in group 1 (TNF-α: 19.4 ± 10.9 pg/ml, IL-6: 5.75 ± 7 pg/ml) compared to the other two groups, although the difference was statistically significant only in the case of TNF-α (group 1: 19.4 ± 10.9 pg/ml, group 2: 14 ± 4.3 pg/ml and control: 8.49 ± 3.69 pg/ml, p = 0.001). There were no differences among pro-inflammatory biomarkers such as erythrocyte sedimentation rate and C reactive protein. among the three groups (p > 0.05). Pro-- inflammatory serum cytokine levels were higher in the diabetes mellitus with diabetic retinopathy group. Larger studies are warranted to establish the real impact of this finding. Copyright © 2015 Academia Mexicana de Cirugía A.C. Published by Masson Doyma México S.A. All rights reserved.

  13. Light and portable novel device for diabetic retinopathy screening.

    PubMed

    Ting, Daniel S W; Tay-Kearney, Mei Ling; Kanagasingam, Yogesan

    2012-01-01

    To validate the use of an economical portable multipurpose ophthalmic imaging device, EyeScan (Ophthalmic Imaging System, Sacramento, CA, USA), for diabetic retinopathy screening. Evaluation of a diagnostic device. One hundred thirty-six (272 eyes) were recruited from diabetic retinopathy screening clinic of Royal Perth Hospital, Western Australia, Australia. All patients underwent three-field (optic disc, macular and temporal view) mydriatic retinal digital still photography captured by EyeScan and FF450 plus (Carl Zeiss Meditec, North America) and were subsequently examined by a senior consultant ophthalmologist using the slit-lamp biomicroscopy (reference standard). All retinal images were interpreted by a consultant ophthalmologist and a medical officer. The sensitivity, specificity and kappa statistics of EyeScan and FF450 plus with reference to the slit-lamp examination findings by a senior consultant ophthalmologist. For detection of any grade of diabetic retinopathy, EyeScan had a sensitivity and specificity of 93 and 98%, respectively (ophthalmologist), and 92 and 95%, respectively (medical officer). In contrast, FF450 plus images had a sensitivity and specificity of 95 and 99%, respectively (ophthalmologist), and 92 and 96%, respectively (medical officer). The overall kappa statistics for diabetic retinopathy grading for EyeScan and FF450 plus were 0.93 and 0.95 for ophthalmologist and 0.88 and 0.90 for medical officer, respectively. Given that the EyeScan requires minimal training to use and has excellent diagnostic accuracy in screening for diabetic retinopathy, it could be potentially utilized by the primary eye care providers to widely screen for diabetic retinopathy in the community. © 2011 The Authors. Clinical and Experimental Ophthalmology © 2011 Royal Australian and New Zealand College of Ophthalmologists.

  14. Color Doppler imaging of the retrobulbar vessels in diabetic retinopathy.

    PubMed

    Pauk-Domańska, Magdalena; Walasik-Szemplińska, Dorota

    2014-03-01

    Diabetes is a metabolic disease characterized by elevated blood glucose level due to impaired insulin secretion and activity. Chronic hyperglycemia leads to functional disorders of numerous organs and to their damage. Vascular lesions belong to the most common late complications of diabetes. Microangiopathic lesions can be found in the eyeball, kidneys and nervous system. Macroangiopathy is associated with coronary and peripheral vessels. Diabetic retinopathy is the most common microangiopathic complication characterized by closure of slight retinal blood vessels and their permeability. Despite intensive research, the pathomechanism that leads to the development and progression of diabetic retinopathy is not fully understood. The examinations used in assessing diabetic retinopathy usually involve imaging of the vessels in the eyeball and the retina. Therefore, the examinations include: fluorescein angiography, optical coherence tomography of the retina, B-mode ultrasound imaging, perimetry and digital retinal photography. There are many papers that discuss the correlations between retrobulbar circulation alterations and progression of diabetic retinopathy based on Doppler sonography. Color Doppler imaging is a non-invasive method enabling measurements of blood flow velocities in small vessels of the eyeball. The most frequently assessed vessels include: the ophthalmic artery, which is the first branch of the internal carotid artery, as well as the central retinal vein and artery, and the posterior ciliary arteries. The analysis of hemodynamic alterations in the retrobulbar vessels may deliver important information concerning circulation in diabetes and help to answer the question whether there is a relation between the progression of diabetic retinopathy and the changes observed in blood flow in the vessels of the eyeball. This paper presents the overview of literature regarding studies on blood flow in the vessels of the eyeball in patients with diabetic

  15. Microalbuminuria could improve risk stratification in patients with TIA and minor stroke.

    PubMed

    Elyas, Salim; Shore, Angela C; Kingwell, Hayley; Keenan, Samantha; Boxall, Leigh; Stewart, Jane; James, Martin A; Strain, William David

    2016-09-01

    Transient ischemic attacks (TIA) and minor strokes are important risk factors for recurrent strokes. Current stroke risk prediction scores such as ABCD2, although widely used, lack optimal sensitivity and specificity. Elevated urinary albumin excretion predicts cardiovascular disease, stroke, and mortality. We explored the role of microalbuminuria (using albumin creatinine ratio (ACR)) in predicting recurrence risk in patients with TIA and minor stroke. Urinary ACR was measured on a spot sample in 150 patients attending a daily stroke clinic with TIA or minor stroke. Patients were followed up at day 7, 30, and 90 to determine recurrent stroke, cardiovascular events, or death. Eligible patients had a carotid ultrasound Doppler investigation. High-risk patients were defined as those who had an event within 90 days or had >50% internal carotid artery (ICA) stenosis. Fourteen (9.8%) recurrent events were reported by day 90 including two deaths. Fifteen patients had severe ICA stenosis. In total, 26 patients were identified as high risk. These patients had a higher frequency of previous stroke or hypercholesterolemia compared to low-risk patients (P = 0.04). ACR was higher in high-risk patients (3.4 [95% CI 2.2-5.2] vs. 1.7 [1.5-2.1] mg/mmol, P = 0.004), independent of age, sex, blood pressure, diabetes, and previous stroke. An ACR greater than 1.5 mg/mmol predicted high-risk patients (Cox proportional hazard ratio 3.5 (95% CI 1.3-9.5, P = 0.01). After TIA or minor stroke, a higher ACR predicted recurrent events and significant ICA stenosis. Incorporation of urinary ACR from a spot sample in the acute setting could improve risk stratification in patients with TIA and minor stroke.

  16. Evaluation of microalbuminuria in relation to asymptomatic bacteruria in Nigerian patients with sickle cell anemia.

    PubMed

    Iwalokun, B A; Iwalokun, S O; Hodonu, S O; Aina, O A; Agomo, P U

    2012-11-01

    Studies have identified microalbuminuria (MA) and asymptomatic bacteruria (ASB) as co-morbid factors in sickle cell anemia (SCA). However, the relationship between these comorbid factors remains unclear and data are lacking for Nigerian patients. This study determined the prevalence of MA and ASB in a cohort of patients with SCA in a steady state, in Lagos, Nigeria. Early morning mid-stream urine samples were collected in sterile bottles from 103 patients comprising 48 males and 55 females with a mean age of 10.4 years. Aerobic culture and colony count of organisms was done using conventional methods. Serum creatinine and hematological indices, including irreversibly sickled cells (ISC), were also assayed. Of the 103 urine samples screened, 23 (22.3%) had albuminuria (ALB), and consisted of nine males and 14 females (P > 0.05); 16.5% of the cases had MA (P <0.05). Age at onset of MA was seven years, and children accounted for 23.5% of all cases with ALB (P >0.05). The prevalence of confirmed ASB was 14.6%, with females accounting for 14 of 19 probable ASB cases (P <0.05). Univariate regression analysis demonstrated a significant (P <0.05) association between age at onset of MA, hemoglobin level, reticulocyte count, ISC and occurrence of ASB, but with only ISC evolving as an independent predictor. Twenty-eight bacterial isolates predominated by Escherichia coli (39.3%; P <0.05), of whom 89.3% were multi-drug resistant, were recovered from the ASB urine samples. In conclusion, both MA and ASB are common in Nigerian SCA patients, with the former occurring from the first decade of life.

  17. A multi-marker approach to predict incident CKD and microalbuminuria.

    PubMed

    Fox, Caroline S; Gona, Philimon; Larson, Martin G; Selhub, Jacob; Tofler, Geoffrey; Hwang, Shih-Jen; Meigs, James B; Levy, Daniel; Wang, Thomas J; Jacques, Paul F; Benjamin, Emelia J; Vasan, Ramachandran S

    2010-12-01

    Traditional risk factors do not adequately identify individuals at risk for CKD. We related a multi-marker panel consisting of the following seven circulating biomarkers to the incidence of CKD and microalbuminuria (MA) in 2345 participants who attended the sixth Framingham Offspring Study examination (1995 to 1998): C-reactive protein, aldosterone, renin, B-type natriuretic peptide (BNP), plasminogen-activator inhibitor type 1, fibrinogen, and homocysteine. We defined CKD at follow-up (2005 to 2008) as estimated GFR (eGFR) <60 ml/min per 1.73 m²; we defined MA as urine albumin-to-creatinine ratio ≥25 (women) or 17 (men) mg/g on spot urine samples. We identified a parsimonious set of markers related to outcomes adjusting for standard risk factors and baseline renal function, and we assessed their incremental predictive utility. During a mean 9.5-year follow-up, 213 participants developed CKD and 186 developed MA. In multivariable logistic regression models, the multi-marker panel was associated with incident CKD (P < 0.001) and MA (P = 0.003). Serum homocysteine and aldosterone both were significantly associated with CKD incidence, and log-transformed aldosterone, BNP, and homocysteine were significantly associated with incident MA. Biomarkers improved risk prediction as measured by improvements in the c-statistics for both CKD and MA and by a 7% increase in net risk reclassification. In conclusion, circulating homocysteine, aldosterone, and BNP provide incremental information regarding risk for incident CKD and MA beyond traditional risk factors.

  18. Predictive modeling using a nationally representative database to identify patients at risk of developing microalbuminuria.

    PubMed

    Villa-Zapata, Lorenzo; Warholak, Terri; Slack, Marion; Malone, Daniel; Murcko, Anita; Runger, George; Levengood, Michael

    2016-02-01

    Predictive models allow clinicians to identify higher- and lower-risk patients and make targeted treatment decisions. Microalbuminuria (MA) is a condition whose presence is understood to be an early marker for cardiovascular disease. The aims of this study were to develop a patient data-driven predictive model and a risk-score assessment to improve the identification of MA. The 2007-2008 National Health and Nutrition Examination Survey (NHANES) was utilized to create a predictive model. The dataset was split into thirds; one-third was used to develop the model, while the other two-thirds were utilized for internal validation. The 2012-2013 NHANES was used as an external validation database. Multivariate logistic regression was performed to create the model. Performance was evaluated using three criteria: (1) receiver operating characteristic curves; (2) pseudo-R (2) values; and (3) goodness of fit (Hosmer-Lemeshow). The model was then used to develop a risk-score chart. A model was developed using variables for which there was a significant relationship. Variables included were systolic blood pressure, fasting glucose, C-reactive protein, blood urea nitrogen, and alcohol consumption. The model performed well, and no significant differences were observed when utilized in the validation datasets. A risk score was developed, and the probability of developing MA for each score was calculated. The predictive model provides new evidence about variables related with MA and may be used by clinicians to identify at-risk patients and to tailor treatment. The risk score developed may allow clinicians to measure a patient's MA risk.

  19. Urinary type IV collagen as a predictor for the incidence of microalbuminuria in young patients with Type 1 diabetes.

    PubMed

    Morita, M; Hanai, K; Uchigata, Y

    2014-02-01

    To clarify whether urinary type IV collagen-to-creatinine ratio is a predictor for the incidence of microalbuminuria in patients with Type 1 diabetes. A longitudinal observational cohort study was conducted; the subjects included normoalbuminuric patients diagnosed with Type 1 diabetes before the age of 30 years and who were less than 40 years old at the start of the observation. In total, 225 patients were enrolled (age, mean ± SD: 25 ± 5 years; male: 32.9%). The endpoint was the incidence of microalbuminuria, defined as 30 mg/g Cr ≤ urinary albumin-to-creatinine ratio < 300 mg/g Cr. Patients were divided into two groups based on the median of urinary type IV collagen-to-creatinine ratio levels. During the median follow-up period of 8.8 years (range 1.0-12.8 years), 13 patients with high urinary type IV collagen-to-creatinine ratio progressed to microalbuminuria. Meanwhile, only one patient with low urinary type IV collagen-to-creatinine ratio reached the endpoint. Kaplan-Meier estimates for the time to reach the endpoint were significantly faster for patients with a high ratio than for those with a low ratio (log-rank test, P < 0.001). In the multivariate Cox hazard analysis, the hazard ratio for patients with high vs. low urinary type IV collagen-to-creatinine ratio was 13.51 (95% CI 1.59-115.02, P = 0.017). When urinary type IV collagen-to-creatinine ratio was treated as a continuous variable, logarithmically transformed urinary type IV collagen-to-creatinine ratio, but not baseline albumin-to-creatinine ratio, was independently associated with reaching the endpoint (hazard ratio 19.23, 95% CI 1.53-242.30, P = 0.022). Urinary type IV collagen may be an important predictor for the incidence of microalbuminuria in young patients with Type 1 diabetes. © 2013 The Authors. Diabetic Medicine © 2013 Diabetes UK.

  20. Implementation of a clinical practice guideline for identification of microalbuminuria in the pediatric patient with type 1 diabetes.

    PubMed

    Montgomery, Kathleen A; Ratcliffe, Sarah J; Baluarte, H Jorge; Murphy, Kathryn M; Willi, Steven; Lipman, Terri H

    2013-06-01

    Evidence-based practice is a shift in the health care culture from basing decisions on consensus opinion, past practice, and precedent toward the use of rigorous analysis of scientific evidence using outcomes research and clinical evidence to guide clinical decision making. The development of evidence-based clinical practice guidelines (CPG) is critical to guide the assessment and management of children with diabetes. This article provides an overview of the infrastructure and processes that are crucial to providing evidence-based care in a large urban pediatric diabetes center. Development of a CPG to identify microalbuminuria in children with type 1 diabetes is discussed.

  1. Dengue Fever Presenting as Purtscher-like Retinopathy.

    PubMed

    Lima, Luiz H; Vianello, Silvana; Pimentel, Sérgio; Costa de Andrade, Gabriel; Zett, Claudio; Muller, Léo; Farah, Michel E; Belfort, Rubens

    2017-03-21

    To report the fundus manifestations and spectral-domain optical coherence tomographic (SD-OCT) features of dengue fever presenting as Purtscher-like retinopathy. Retrospective review of two cases of dengue fever. Color fundus photograph revealed the presence of cotton-wool spots in a Purtscher-like configuration in the posterior pole of all study eyes. SD-OCT demonstrated increased reflectivity signal in the inner retinal layers, and after a variable follow-up period, there was complete disappearance of cotton-wool spots and persistence of the hyperreflectivity signal. We report two unique cases of dengue fever associated with retinal lesions in a configuration of Purtscher-like retinopathy.

  2. Vessel discoloration detection in malarial retinopathy

    NASA Astrophysics Data System (ADS)

    Agurto, C.; Nemeth, S.; Barriga, S.; Soliz, P.; MacCormick, I.; Taylor, T.; Harding, S.; Lewallen, S.; Joshi, V.

    2016-03-01

    Cerebral malaria (CM) is a life-threatening clinical syndrome associated with malarial infection. It affects approximately 200 million people, mostly sub-Saharan African children under five years of age. Malarial retinopathy (MR) is a condition in which lesions such as whitening and vessel discoloration that are highly specific to CM appear in the retina. Other unrelated diseases can present with symptoms similar to CM, therefore the exact nature of the clinical symptoms must be ascertained in order to avoid misdiagnosis, which can lead to inappropriate treatment and, potentially, death. In this paper we outline the first system to detect the presence of discolored vessels associated with MR as a means to improve the CM diagnosis. We modified and improved our previous vessel segmentation algorithm by incorporating the `a' channel of the CIELab color space and noise reduction. We then divided the segmented vasculature into vessel segments and extracted features at the wall and in the centerline of the segment. Finally, we used a regression classifier to sort the segments into discolored and not-discolored vessel classes. By counting the abnormal vessel segments in each image, we were able to divide the analyzed images into two groups: normal and presence of vessel discoloration due to MR. We achieved an accuracy of 85% with sensitivity of 94% and specificity of 67%. In clinical practice, this algorithm would be combined with other MR retinal pathology detection algorithms. Therefore, a high specificity can be achieved. By choosing a different operating point in the ROC curve, our system achieved sensitivity of 67% with specificity of 100%.

  3. Retinal vascular changes in hypertensive patients in Ibadan, Sub-Saharan Africa.

    PubMed

    Oluleye, Sunday Tunji; Olusanya, Bolutife Ayokunu; Adeoye, Abiodun Moshood

    2016-01-01

    Earlier studies in Nigeria reported the rarity of retinal vascular changes in hypertensives. The aim of this study was to describe the various retinal vascular changes in the hypertensive patients of Nigeria. Nine hundred and three hypertensive patients were studied. This study was approved by the ethical and research committee of the University of Ibadan and University College Hospital, Ibadan, Nigeria. Blood pressure and anthropometric measurements were measured. Cardiac echocardiography was performed on 156 patients. All patients had dilated fundoscopy and fundus photography using the Kowa portable fundus camera and an Apple iPhone with 20 D lens. Statistical analysis was done with Statistical Packages for the Social Sciences (Version 21). The mean age of patients was 57 years with a male:female ratio of 1. No retinopathy was found in 556 (61.5%) patients. In all, 175 (19.4%) patients had features of hypertensive retinopathy. Retinal vascular occlusion was a significant finding in 121 patients (13.4%), of which branch retinal vein occlusion, 43 (4.7%), and central retinal vein occlusion, 30 (3.3%), were the most prominent ones in cases. Hemicentral retinal vein occlusion, 26 (2.9%), and central retinal artery occlusion, 17 (1.9%), were significant presentations. Other findings included nonarteritic anterior ischemic optic neuropathy in five (0.6%) patients, hypertensive choroidopathy in seven (0.8%) patients, and hemorrhagic choroidal detachment in five (0.6%) patients. Left ventricular (LV) geometry was abnormal in 85 (55.5%) patients. Concentric remodeling, eccentric hypertrophy, and concentric hypertrophy were observed in 43 (27.6%), 26 (17.2%), and 15 (9.7%) patients, respectively. LV hypertrophy was found in 42 (27%) patients, while 60 (39%) patients had increased relative wall thickness. In this study, bivariate analysis showed a correlation between LV relative wall thickness and severity of retinopathy in both eyes (Spearman's coefficient 0.6; P=0

  4. Genetic susceptibility to retinopathy of prematurity: the evidence from clinical and experimental animal studies.

    PubMed

    Holmström, Gerd; van Wijngaarden, Peter; Coster, Douglas J; Williams, Keryn A

    2007-12-01

    Despite advances in management and treatment, retinopathy of prematurity remains a major cause of childhood blindness. Evidence for a genetic basis for susceptibility to retinopathy of prematurity is examined, including the influences of sex, ethnicity, and ocular pigmentation. The role of polymorphisms is explored in the genes for vascular endothelial growth factor and insulin-like growth factor-1, and of mutations in the Norrie disease gene. Insights into the genetic basis of retinopathy of prematurity provided by the animal model of oxygen induced retinopathy are examined. Evidence for a genetic component for susceptibility to retinopathy of prematurity is strong, although the molecular identity of the gene or genes involved remains uncertain.

  5. Types of Pulmonary Hypertension

    MedlinePlus

    ... Hypertension The World Health Organization divides pulmonary hypertension (PH) into five groups. These groups are organized based ... lungs. Group 2 Pulmonary Hypertension Group 2 includes PH with left heart disease. Conditions that affect the ...

  6. Pulmonary Hypertension Overview

    MedlinePlus

    ... pulmonary hypertension usually limit a person’s ability to exercise and do other activities. CausesWhat causes pulmonary hypertension?Many things can cause pulmonary hypertension. However, sometimes ...

  7. Hypertension (High Blood Pressure)

    MedlinePlus

    ... Visitor Information RePORT NIH Fact Sheets Home > Hypertension (High Blood Pressure) Small Text Medium Text Large Text Hypertension (High Blood Pressure) YESTERDAY Hypertension is a silent killer because it ...

  8. Treating Hypertension in Pregnancy.

    PubMed

    Schlembach, Dietmar; Homuth, Volker; Dechend, Ralf

    2015-08-01

    Hypertension is present in about 10 % of all pregnancies. The frequency of chronic hypertension and that of gestational hypertension is increasing. The management of pregnant women with hypertension remains a significant, but controversial, public health problem. Although treatment of hypertension in pregnancy has shown to reduce maternal target organ damage, considerable debate remains concerning treatment. We review current evidence regarding treatment goals, the ideal treatment starting time, and which drugs are available for the treatment of hypertension in pregnancy.

  9. Essential hypertension vs. secondary hypertension among children.

    PubMed

    Gupta-Malhotra, Monesha; Banker, Ashish; Shete, Sanjay; Hashmi, Syed Sharukh; Tyson, John E; Barratt, Michelle S; Hecht, Jacqueline T; Milewicz, Diane M; Boerwinkle, Eric

    2015-01-01

    The aim was to determine the proportions and correlates of essential hypertension among children in a tertiary pediatric hypertension clinic. We evaluated 423 consecutive children and collected demographic and clinical history by retrospective chart review. We identified 275 (65%) hypertensive children (blood pressure >95th percentile per the "Fourth Report on the Diagnosis, Evaluation, and Treatment of High Blood Pressure in Children and Adolescents") from 423 children referred to the clinic for history of elevated blood pressure. The remainder of the patients had normotension (11%), white coat hypertension (11%), prehypertension (10%), and pending diagnosis (3%). Among the 275 hypertensive children, 43% (n = 119; boys = 56%; median age = 12 years; range = 3-17 years) had essential hypertension and 57% (n = 156; boys = 66%; median age = 9 years; range = 0.08-19 years) had secondary hypertension. When compared with those with secondary hypertension, those with essential hypertension had a significantly older age at diagnosis (P = 0.0002), stronger family history of hypertension (94% vs. 68%; P < 0.0001), and lower prevalence of preterm birth (20% vs. 46%; P < 0.001). There was a bimodal distribution of age of diagnosis in those with secondary hypertension. The phenotype of essential hypertension can present as early as 3 years of age and is the predominant form of hypertension in children after age of 6 years. Among children with hypertension, those with essential hypertension present at an older age, have a stronger family history of hypertension, and have lower prevalence of preterm birth. © American Journal of Hypertension, Ltd 2014. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  10. Subfoveal choroidal thickness in diabetes and diabetic retinopathy.

    PubMed

    Xu, Jie; Xu, Liang; Du, Kui Fang; Shao, Lei; Chen, Chang Xi; Zhou, Jin Qiong; Wang, Ya Xing; You, Qi Sheng; Jonas, Jost B; Wei, Wen Bin

    2013-10-01

    To examine subfoveal choroidal thickness (SFCT) in patients with diabetes mellitus and patients with diabetic retinopathy. Population-based, cross-sectional study. The population-based Beijing Eye Study 2011 included 3468 individuals with a mean age of 64.6 ± 9.8 years (range, 50-93 years). A detailed ophthalmic examination was performed including spectral-domain optical coherence tomography (OCT) with enhanced depth imaging for measurement of SFCT and fundus photography for the assessment of diabetic retinopathy. Subfoveal choroidal thickness. Fasting blood samples, fundus photographs, and choroidal OCT images were available for 2041 subjects (58.8%), with 246 subjects (12.1 ± 0.7%) fulfilling the diagnosis of diabetes mellitus and 23 subjects having diabetic retinopathy. Mean SFCT did not differ significantly between patients with diabetes mellitus and nondiabetic subjects (266 ± 108 vs. 261 ± 103 μm; P=0.43) nor between patients with diabetic retinopathy and subjects without retinopathy (249 ± 86 vs. 262 ± 104 μm; P = 0.56). After adjustment for age, sex, axial length, lens thickness, anterior chamber depth, corneal curvature radius, and best-corrected visual acuity, SFCT was associated with a higher glycosylated hemoglobin (HbA1c) value (P<0.001; regression coefficient B, 8.18; 95% confidence interval [CI], 4.02-12.3); standardized coefficient β, 0.08) or with the presence of diabetes mellitus (P = 0.001; B, 21.3; 95% CI, 9.12-33.5) but not with presence of diabetic retinopathy (P = 0.61) or stage of diabetic retinopathy (P = 0.14). As a corollary, after adjusting for age, region of habitation, body mass index, systolic and diastolic blood pressure, and level of education, diabetes mellitus was associated with a thicker SFCT (P<0.001). In contrast, neither presence of diabetic retinopathy (P = 0.61) nor stage of diabetic retinopathy (P = 0.09) were associated significantly with SFCT after adjusting for body mass index, diastolic and systolic blood

  11. Management of diabetes mellitus and hypertension at UNRWA primary health care facilities in Lebanon.

    PubMed

    Yusef, J I

    2000-01-01

    A cross-sectional descriptive study was conducted at all UNRWA primary health care facilities in Lebanon Field, to assess the quality of care of diabetes mellitus and hypertension. The study reviewed 2202 records of diabetic and hypertensive patients. Both diseases were present at an early age (< 40 years), with family history, obesity and sedentary lifestyle being the main risk factors. The major complication was cardiovascular disease followed by retinopathy. Action-oriented measures to improve the organization and management of the health care services were identified.

  12. Prevalence and associations of diabetic retinopathy in a large cohort of prediabetic subjects: the Gutenberg Health Study.

    PubMed

    Lamparter, Julia; Raum, Philipp; Pfeiffer, Norbert; Peto, Tunde; Höhn, René; Elflein, Heike; Wild, Philipp; Schulz, Andreas; Schneider, Astrid; Mirshahi, Alireza

    2014-01-01

    To evaluate the prevalence of diabetic retinopathy/maculopathy (DR/DMac) and its associations with cardiovascular risk factors (CRF) in participants with prediabetes (PwPD) in a large European cohort within the population-based Gutenberg Health Study (GHS). The study was based on a sub-cohort of the GHS (n=5,000, age: 35-74 y). Prediabetes was diagnosed according to HbA1c levels (5.7-6.4%). DR/DMac was graded from fundus photographs. Blood samples and comprehensive questionnaires served for evaluation of laboratory results and CRF. The prevalence of prediabetes was 22.4%, and of DR/DMac 8.1%/0.2%, respectively. The majority of participants had mild DR (7.2%). A percentage of 0.5 of PwPD presented with moderate and 0.3% with severe non-proliferative disease. None of the subjects had proliferative DR. No independent association was found between any of the analyzed CRF [hypertension, smoking, (family) history of myocardial infarction, congestive heart failure, coronary heart disease, stroke, obesity, dyslipidemia, chronic obstructive pulmonary disease, peripheral artery disease and chronic kidney disease] and DR. Although prevalences of prediabetes and DR in this Caucasian cohort are considerable, retinopathy findings are mainly mild, and no association was found for DR/DMac and CRF. Copyright © 2014 Elsevier Inc. All rights reserved.

  13. [Prevalence and risk factors for sickle retinopathy in a sub-Saharan comprehensive Sickle Cell Center].

    PubMed

    Dembélé, A K; Toure, B A; Sarro, Y S; Guindo, A; Fané, B; Offredo, L; Kené, S; Conaré, I; Tessougué, O; Traoré, Y; Badiaga, Y; Sidibé, M B; Diabaté, D; Coulibaly, M; Kanta, M; Ranque, B; Diallo, D A

    2017-09-01

    Retinopathy is a chronic complication with severe functional consequences in patients with sickle cell disease. Its prevalence is not well known in sub-Saharan Africa because of the absence of screening. We report here the results of a routine screening for sickle retinopathy in a Comprehensive Sickle Cell Center in Sub-Saharan Africa. Screening of sickle retinopathy was carried out in all sickle cell patients aged 10 and over, followed between 2010 and 2012. Retinopathy was screened by dilated indirect fundoscopic examination and retinal angiography, if necessary. The gender, age and hematological parameters of patients with sickle retinopathy were compared with those of controls randomly selected from the cohort of sickle cell patients without retinopathy followed during the same period. The overall prevalence of sickle cell retinopathy was 8.8% (142/1604): 12.4% (91/731) in SC, 5.2% (38/734) in SS, 9.4% (5/53) in Sβ°-thalassemia patients and 9.3% (8/86) in Sβ(+)-thalassemia patients. Proliferative retinopathy was more common in SC patients (P<0.01). High levels of hemoglobin or of hematocrit were associated with retinopathy in all patients and with proliferative retinopathy in SC patients. In SS or Sβ(0)thalassemia patients, high leukocyte count was associated with proliferative retinopathy. Low fetal hemoglobin level was associated with retinopathy in all groups. The prevalence of sickle cell retinopathy is high and negatively associated to the level of fetal hemoglobin. The efficiency of a routine screening for sickle cell retinopathy must be assessed in Africa as well as the benefit of phlebotomy and hydroxyurea therapy as a preventive treatments. Copyright © 2017 Société Nationale Française de Médecine Interne (SNFMI). Published by Elsevier SAS. All rights reserved.

  14. Prevalence and Cardiovascular Associations of Diabetic Retinopathy and Maculopathy: Results from the Gutenberg Health Study

    PubMed Central

    Raum, Philipp; Lamparter, Julia; Ponto, Katharina A.; Peto, Tunde; Hoehn, René; Schulz, Andreas; Schneider, Astrid; Wild, Philipp S.; Pfeiffer, Norbert; Mirshahi, Alireza

    2015-01-01

    Objective Diabetic retinopathy (DR) is the leading cause of blindness in people of working age. The purpose of this paper is to report the prevalence and cardiovascular associations of diabetic retinopathy and maculopathy (DMac) in Germany. Research Design and Methods The Gutenberg Health Study (GHS) is a population-based study with 15,010 participants aged between 35 at 74 years from the city of Mainz and the district of Mainz-Bingen. We determined the weighted prevalence of DR and DMac by assessing fundus photographs of persons with diabetes from the GHS data base. Diabetes was defined as HbA1c ≥ 6.5%, known diagnosis diabetes mellitus or known diabetes medication. Furthermore, we analysed the association between DR and cardiovascular risk factors and diseases. Results Overall, 7.5% (1,124/15,010) of the GHS cohort had diabetes. Of these, 27.7% were unaware of their disease and thus were newly diagnosed by their participation in the GHS. The prevalence of DR and DMac was 21.7% and 2.3%, respectively among patients with diabetes. Vision-threatening disease was present in 5% of the diabetic cohort. In the multivariable analysis DR (all types) was associated with age (Odds Ratio [95% confidence interval]: 0.97 [0.955–0.992]; p = 0.006) arterial hypertension (1.90 [1.190–3.044]; p = 0.0072) and vision-threatening DR with obesity (3.29 [1.504–7.206]; p = 0.0029). DR (all stages) and vision-threatening DR were associated with duration of diabetes (1.09 [1.068–1.114]; p<0.0001 and 1.18 [1.137–1.222]; p<0.0001, respectively). Conclusions Our calculations suggest that more than a quarter-million persons have vision-threatening diabetic retinal disease in Germany. Prevalence of DR was lower in the GHS compared to East-Asian studies. Associations were found with age, arterial hypertension, obesity, and duration of diabetes mellitus. PMID:26075604

  15. Essential Hypertension vs. Secondary Hypertension Among Children

    PubMed Central

    Banker, Ashish; Shete, Sanjay; Hashmi, Syed Sharukh; Tyson, John E.; Barratt, Michelle S.; Hecht, Jacqueline T.; Milewicz, Diane M.; Boerwinkle, Eric

    2015-01-01

    BACKGROUND The aim was to determine the proportions and correlates of essential hypertension among children in a tertiary pediatric hypertension clinic. METHODS We evaluated 423 consecutive children and collected demographic and clinical history by retrospective chart review. RESULTS We identified 275 (65%) hypertensive children (blood pressure >95th percentile per the “Fourth Report on the Diagnosis, Evaluation, and Treatment of High Blood Pressure in Children and Adolescents”) from 423 children referred to the clinic for history of elevated blood pressure. The remainder of the patients had normotension (11%), white coat hypertension (11%), prehypertension (10%), and pending diagnosis (3%). Among the 275 hypertensive children, 43% (n = 119; boys = 56%; median age = 12 years; range = 3–17 years) had essential hypertension and 57% (n = 156; boys = 66%; median age = 9 years; range = 0.08–19 years) had secondary hypertension. When compared with those with secondary hypertension, those with essential hypertension had a significantly older age at diagnosis (P = 0.0002), stronger family history of hypertension (94% vs. 68%; P < 0.0001), and lower prevalence of preterm birth (20% vs. 46%; P < 0.001). There was a bimodal distribution of age of diagnosis in those with secondary hypertension. CONCLUSIONS The phenotype of essential hypertension can present as early as 3 years of age and is the predominant form of hypertension in children after age of 6 years. Among children with hypertension, those with essential hypertension present at an older age, have a stronger family history of hypertension, and have lower prevalence of preterm birth. PMID:24842390

  16. Augmentation Pressure and Subendocardial Viability Ratio are associated with microalbuminuria and with poor renal function in type 1 diabetes

    PubMed Central

    Prince, Catherine T.; Secrest, Aaron M.; Mackey, Rachel H.; Arena, Vincent C.; Kingsley, Lawrence A.; Orchard, Trevor J.

    2011-01-01

    This report explores the hypothesis that arterial stiffness indices, which predict cardiovascular disease, might also correlate with microalbuminuria (MA) in type 1 diabetes (T1D), and thus have potential for risk assessment. Three pulse wave analysis indices, measured using the SphygmoCor device, were evaluated on 144 participants with childhood-onset T1D. These variables, augmentation index (AIx) and augmentation pressure (AP), and subendocardial viability ratio (SEVR, an estimate of myocardial perfusion) were each analyzed cross-sectionally in relation to both prevalent MA (defined as albumin excretion rate (AER)=20–199 μg/min) and renal function (assessed by both estimated glomerular filtration rate (eGFR) and serum cystatin C). AP and SEVR were each univariately associated with AER, eGFR and cystatin C. Lower SEVR was also independently related to the presence of microalbuminuria and degree of albuminuria within normo- and microalbuminuric participants. SEVR, not AP, was independently and negatively associated with both measures of renal function. SEVR is a better predictor of AER than brachial blood pressure measures in those without clinical proteinuria, indicating a potential use for pulse wave analysis in the early detection of individuals at risk for cardiovascular and renal complication of T1D. PMID:20605853

  17. Clinical features of 8295 patients with resistant hypertension classified on the basis of ambulatory blood pressure monitoring.

    PubMed

    de la Sierra, Alejandro; Segura, Julián; Banegas, José R; Gorostidi, Manuel; de la Cruz, Juan J; Armario, Pedro; Oliveras, Anna; Ruilope, Luis M

    2011-05-01

    We aimed to estimate the prevalence of resistant hypertension through both office and ambulatory blood pressure monitoring in a large cohort of treated hypertensive patients from the Spanish Ambulatory Blood Pressure Monitoring Registry. In addition, we also compared clinical features of patients with true or white-coat-resistant hypertension. In December 2009, we identified 68 045 treated patients with complete information for this analysis. Among them, 8295 (12.2% of the database) had resistant hypertension (office blood pressure ≥140 and/or 90 mm Hg while being treated with ≥3 antihypertensive drugs, 1 of them being a diuretic). After ambulatory blood pressure monitoring, 62.5% of patients were classified as true resistant hypertensives, the remaining 37.5% having white-coat resistance. The former group was younger, more frequently men, with a longer duration of hypertension and a worse cardiovascular risk profile. The group included larger proportions of smokers, diabetics, target organ damage (including left ventricular hypertrophy, impaired renal function, and microalbuminuria), and documented cardiovascular disease. Moreover, true resistant hypertensives exhibited in a greater proportion a riser pattern (22% versus 18%; P<0.001). In conclusion, this study first reports the prevalence of resistant hypertension in a large cohort of patients in usual daily practice. Resistant hypertension is present in 12% of the treated hypertensive population, but among them more than one third have normal ambulatory blood pressure. A worse risk profile is associated with true resistant hypertension, but this association is weak, thus making it necessary to assess ambulatory blood pressure monitoring for a correct diagnosis and management.

  18. Results of laser treatment-PRP to the diabetic retinopathy.

    PubMed

    Ajvazi, Halil; Goranci, Ilhami; Goranci, Ardiana; Govori, Valbona; Goranci, Dafina

    2009-01-01

    Diabetic retinopathy-(DR) presents the most aggressive form of the retinopathy that has progressive movement and often it ends with optic-atrophic blindness end includes heavy complications unless carried out by laser pan-retinal-photocoagulation. The aim of this study was analyzing the diabetic retinopathy and impact of the PRP laser treatment, proposition of the precautious as well to managing the complications and PDR prevention. In this study were presented the treatment results of diabetic retinopathy treated in the Eye's Clinic in Prishtina, during the period of time (2004-2009). There were examined and diagnosed 42 patients with DR of whom 24 males or (57.14%) and 18 females or (42.85%). In 18 patients or (27%) we have had improvement, in 35 cases or (53%) stabilization and 13 cases or (20%) worsening of state after laser treatment with PRP to DR. The most frequently complications were vitreous hemorrhage in 5 cases or (38.46%) and blindness in 3 cases or (23.07%). There have been used statistical methods of processing and analysis according to the WHO standards. We consider that through an advanced education and research programs for inovative projects that meet criterias of our strategic targets to protecting the retina and optic-nerv by understanding DR and PDR and developing a better laser treatment and accurately monitoring of DM, we can manage to prevent complications and heavy consequences of DR. In order to achieve this aim we have to work hard to standardized protocols.

  19. Posterior Retinal Hemorrhages during Retcam Examination for Retinopathy of Prematurity.

    PubMed

    Chandra, Parijat; Azad, Rajvardhan

    2016-11-07

    Retcam-assisted retinopathy of prematurity (ROP) screening is a commonly used safe examination procedure. A preterm baby born at 32 weeks gestation age developed extensive posterior retinal hemorrhages during retinal imaging using the RetCam. Retinal hemorrhages spontaneously resolved. As tele screening is becomes more popular, proper training for Retcam usage is essential.

  20. A Review of Ranibizumab for the Treatment of Diabetic Retinopathy.

    PubMed

    Stewart, Michael W

    2017-06-01

    Laser photocoagulation has been the standard treatment for diabetic macular edema (DME) and proliferative diabetic retinopathy (PDR) for several decades. The discovery of vascular endothelial growth factor (VEGF) and the subsequent determination of its critical role in the development DME and PDR has led to the development of VEGF inhibitory drugs. Ranibizumab was the first anti-VEGF drug approved for the treatment of both DME and diabetic retinopathy in eyes with DME. Medline searches with the keywords "ranibizumab," "diabetic macular edema," and "proliferative diabetic retinopathy" were performed to identify pertinent pre-clinical studies and clinical trials. Top-line data, with emphasis on pivotal trials, was identified and incorporated into this manuscript. Findings from small uncontrolled trials were generally not used unless they filled important gaps in our understanding of anti-VEGF therapy. Ranibizumab is a recombinant humanized antibody fragment that binds all isoforms of VEGF-A with high affinity. Three parallel lines of clinical research have produced level I evidence supporting the superiority of ranibizumab over laser photocoagulation for the treatment of DME. Regular injections also lead to improvement in diabetic retinopathy severity scores in a large minority of eyes. Ranibizumab is effective for PDR and produces less visual field loss than laser photocoagulation. It has an excellent safety profile, with low incidence of ocular and systemic adverse events. Ranibizumab has become a frequently used first-line therapy for the treatment of DME. Emerging data suggest that it may become an important treatment for DR and PDR.

  1. Automated detection of diabetic retinopathy lesions on ultrawidefield pseudocolour images.

    PubMed

    Wang, Kang; Jayadev, Chaitra; Nittala, Muneeswar G; Velaga, Swetha B; Ramachandra, Chaithanya A; Bhaskaranand, Malavika; Bhat, Sandeep; Solanki, Kaushal; Sadda, SriniVas R

    2017-09-19

    We examined the sensitivity and specificity of an automated algorithm for detecting referral-warranted diabetic retinopathy (DR) on Optos ultrawidefield (UWF) pseudocolour images. Patients with diabetes were recruited for UWF imaging. A total of 383 subjects (754 eyes) were enrolled. Nonproliferative DR graded to be moderate or higher on the 5-level International Clinical Diabetic Retinopathy (ICDR) severity scale was considered as grounds for referral. The software automatically detected DR lesions using the previously trained classifiers and classified each image in the test set as referral-warranted or not warranted. Sensitivity, specificity and the area under the receiver operating curve (AUROC) of the algorithm were computed. The automated algorithm achieved a 91.7%/90.3% sensitivity (95% CI 90.1-93.9/80.4-89.4) with a 50.0%/53.6% specificity (95% CI 31.7-72.8/36.5-71.4) for detecting referral-warranted retinopathy at the patient/eye levels, respectively; the AUROC was 0.873/0.851 (95% CI 0.819-0.922/0.804-0.894). Diabetic retinopathy (DR) lesions were detected from Optos pseudocolour UWF images using an automated algorithm. Images were classified as referral-warranted DR with a high degree of sensitivity and moderate specificity. Automated analysis of UWF images could be of value in DR screening programmes and could allow for more complete and accurate disease staging. © 2017 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

  2. Long-term Choroidal Thickness Changes After Acute Solar Retinopathy.

    PubMed

    Akay, Fahrettin; Toyran, Sami; Oztas, Zafer; Koksal, Serkan

    2015-01-01

    To identify long-term changes in choroidal thickness after solar retinopathy. The study included 25 eyes of 25 men with acute solar retinopathy. Ocular examination, best corrected visual acuity (BCVA), and retinal and choroidal thickness measurements obtained using spectral-domain optical coherence tomography were evaluated. The mean follow-up was 6.1 ± 0.4 months. The initial BCVA decreased in the affected eyes (P < .001). The mean BCVA (logMAR) improved significantly from 0.16 ± 0.06 to 0.03 ± 0.05 at 6 months (P < .001). There were no significant differences in the initial retinal and choroidal thicknesses between the affected and other eyes, while there was a significant decrease in the mean macular thickness and mean macular volume at 1 month and the mean choroidal thickness increased (P < .001). Significant retinal and choroidal thickness changes occurred after solar retinopathy. The changes in choroidal thickness suggest that the effects of solar retinopathy might not be limited to the retina. Copyright 2015, SLACK Incorporated.

  3. Foveo-macular retinitis, solar retinopathy, and trauma.

    PubMed Central

    Grey, R. H.

    1978-01-01

    Three patients are described with foveal lesions resembling minute holes following trauma. The similarity of the lesions to foveomacular retinitis and solar retinopathy suggests that all these conditions produce a similar, localised neuroretinal lesion with sparing of the pigment epithelium. Loss of the photoreceptors at the fovea would be expected to produce a lesion resembling a small retinal hole. Images PMID:687552

  4. [Clinico-pathological characteristics and prognosis of IgA nephropathy patients with microalbuminuria and deposition of complement C3].

    PubMed

    Guo, Z Y; Zhou, S G; Wang, Y Y; Li, X; Xu, Y; Du, X Y; Zhang, W; Wu, Y M

    2016-03-08

    To analyze the clinical and pathological data and prognosis of IgA nephropathy patients with microalbuminuria and deposition of C3, and to investigate the significance of C3 deposition in IgA nephropathy with microalbuminuria. The clinical and pathological data of 127 IgA nephropathy patients with microalbuminuria confirmed by renal biopsy in the Jining No.1 People's Hospital from January 2009 to January 2015 and minimum 6-month follow-up was reviewed, and patients were divided into positive group (72 cases, 56.7%)and negative group (55 cases, 43.3%) according to the deposition of C3 in the mesangial area of glomeruli. 24 h urine quantitative protein being more than 1 g, or serum creatinine level becoming abnormal or double by renal biopsy was defined as endpoint of follow-up. Renal survival was calculated by Kaplan-Meier survival analysis. A total of 127 IgA nephropathy patients with microalbuminuria were followed up successfully, with an average follow-up of (49.6±22.7) months. 24 h urine albumin[(261.3±47.4) vs (238.7±51.9) mg, P=0.011], serum creatinine value[98.0(56.4, 118.6) vs 85.7(51.9, 107.8) μmol/L, P=0.003], uric acid value[(384.0±93.7) vs (360.5±88.4) μmol/L, P=0.043] and serum IgA value[(3.36±1.17) vs (3.12±1.05) g/L, P=0.044] were significantly higher in the C3 positive group than those in the negative group, while the serum complement C3 was significantly lower [(0.70±0.42) vs (0.98±0.49) mg, P=0.047]. Pathological changes [Lee's grade Ⅲ and above Ⅲ: 21(16.5%) vs 11(8.7%), P=0.034], glomerular sclerosis or adhesions [29(22.8%) vs 19(15.0%), P=0.047], renal tubular atrophy or interstitial fibrosis [13(10.2%) vs 8(6.3%), P=0.027] and crescent formation [7(5.5%) vs 2(1.6%), P=0.035] in the complement C3 positive group were more severe than those in the negative group. 38 cases of complement C3 positive group and 14 cases of negative group accomplished the study, and Kaplan-Meier survival analysis showed that there was a significant

  5. [Comparison of early retinal microvascular changes and microalbuminuria as indicators for increased cardioascular risk].

    PubMed

    Huchzermeyer, C; Schaller, B; Schmid, K; Schmieder, R E; Michelson, G

    2011-11-01

    Prevention of cardiovascular disease is an important goal in clinical medicine and public health. In the process, the diagnosis of early end-organ damage is a priority beside the treatment of classic cardiovascular risk factors. To achieve this, the ophthalmoscopic examination of the retinal vessels plays a prominent role. Alternatively, the quantification of low quantities of albumin in the urine (microalbuminuria) allows the detection of early vascular damage in the kidney. The question is addressed as to whether these two methods are interchangeable or are rather complementary. We examined 226 members of the staff of the University Hospital Erlangen who volunteered to participate in a preventive campaign. A comprehensive history was taken, and height, weight and blood pressure were measured. Analysis of serum lipids and determination of the urinary albumin/creatinine ratio were performed. Fotos of the central fundus were taken with a non-mydriatic camera and analysed by an experienced ophthalmologist in a standardised fashion. The risk for cardiovascular mortality within the next ten years was estimated from age, sex, blood pressure and serum cholesterol using the euroSCORE tables for Germany. There was no signficant correlation between the arteriovenous ratio of the retinal vessels and the urinary albumin/creatinine ratio. Neither parameter correlated with the euroSCORE Germany. Arteriovenous crossings and focal narrowing of the retinal vessels were associated signficantly with an elevated euroSCORE risk. In large population-based studies, the arteriovenous ratio and the urinary albumin/creatinine ratio have been confirmed as markers of cardiovascular risk. In our study, there was no correlation between these two parameters. Thus, they seem to present independent risk markers. The presence of arteriovenous crossings and focal narrowing seems to be linked more closely to the classic cardiovascular risk factors from which the euroSCORE is calculated. The

  6. Role of Microalbuminuria in Predicting Cardiovascular Mortality in Individuals With Subclinical Hypothyroidism.

    PubMed

    Tuliani, Tushar A; Shenoy, Maithili; Belgrave, Kevin; Deshmukh, Abhishek; Pant, Sadip; Hilliard, Anthony; Afonso, Luis

    2017-09-01

    Studies suggest that subclinical hypothyroidism (SCH) is related to cardiovascular mortality (CVM). We explored the role of microalbuminuria (MIA) as a predictor of long-term CVM in population with and without SCH with normal kidney function. We examined the National Health and Nutrition Education Survey - III database (n = 6,812). Individuals younger than 40 years, thyroid-stimulating hormone levels ≥20 and ≤0.35mIU/L, estimated glomerular filtration rate <60mL/minute/1.73m(2) and urine albumin-to-creatinine ratio of >250mg/g in men and >355mg/g in women were excluded. SCH was defined as thyroid-stimulating hormone levels between 5 and 19.99mIU/L and serum T4 levels between 5 and 12µg/dL. MIA was defined as urine albumin-to-creatinine ratio of 17-250mg/g in men and 25-355mg/g in women. Patients were categorized into the following 4 groups: (1) no SCH or MIA, (2) MIA, but no SCH, (3) SCH, but no MIA and (4) both SCH and MIA. Prevalence of MIA in the subclinical hypothyroid cohort was 21% compared to 16.4% in those without SCH (P = 0.03). SCH was a significant independent predictor of MIA (n = 6,812), after adjusting for traditional risk factors (unadjusted odds ratio = 1.75; 95% CI: 1.24-2.48; P = 0.002 and adjusted odds ratio = 1.83; 95% CI: 1.2-2.79; P = 0.006). MIA was a significant independent predictor of long-term all-cause (adjusted hazard ratio = 1.7, 95% CI: 1.24-2.33) and CVM (adjusted hazard ratio = 1.72, 95% CI: 1.07-2.76) in subclinical hypothyroid individuals. In a cohort of subclinical hypothyroid individuals, the presence of MIA predicts increased risk of CVM as compared to nonmicroalbuminurics with SCH. Further randomized trials are needed to assess the benefits of treating microalbuminuric subclinical hypothyroid individuals and impact on CVM. Copyright © 2017 Southern Society for Clinical Investigation. Published by Elsevier Inc. All rights reserved.

  7. Demographic features and visual outcomes of patients presenting to diabetic photo-screening and treated for sight threatening retinopathy in Fiji

    PubMed Central

    Bhikoo, Riyaz; Murray, Neil; Sikivou, Biu; Emma, Stephanie; McGhee, Charles

    2017-01-01

    AIM To describe the demographic features and visual outcomes of patients presenting to photo-screening services, and treated for sight threatening retinopathy (STR) in a low resource setting, Fiji. METHODS A retrospective review of all new patients who presented for diabetic photo-screening at the Diabetic Eye Clinic, Suva in 2010. Fundus images were graded using standardised guidelines. Patient demographics, retinopathy grading and visual acuity data were extracted from the database and analyzed. Patients that received laser therapy and still attending follow up in 2012 were examined for disease progression. RESULTS Totally 2236 patients were photo-screened, 87% (3870/4472) of images were gradable. STR was observed in 26% (988/3870) with advanced STR (proliferative retinopathy/severe maculopathy) in 10% (385/3870). Of those with STR, 59% had BCVA ≥6/18, 31% with advanced STR were <6/60. Male gender [odds ratio (OR) 1.59; 1.20-2.12], history of hypertension (OR 1.36; 1.03-1.80) and peripheral neuropathy (OR 1.41; 1.01-1.95) were predictive of advanced STR. In 2012, 32% (315/988) attended follow up with 69% exhibiting advanced STR compared with 53% of the same cohort in 2010. Laser photocoagulation was administered to 212 eyes (212/3870, 5%) with retinopathy and maculopathy progression observed in 52% and 33% respectively. BCVA ≥6/18 was noted in 67% (143/212) of treated eyes. Improved glycaemic control (OR 46.52; 1.50-1441.90) amongst those with advanced STR was predictive of eyes that maintained good vision. CONCLUSION In Fiji, a quarter of new patients presenting to photo-screening have STR with a third of those with advanced STR having already loss vision. Improved glycaemic control and timely treatment of patients with sight threatening complications is important in halting disease progression. PMID:28546939

  8. Correlation of various serum biomarkers with the severity of diabetic retinopathy.

    PubMed

    Nalini, M; Raghavulu, B V; Annapurna, A; Avinash, P; Chandi, Vishala; Swathi, N; Wasim

    2017-04-08

    Hyperglycemia induced inflammation and angiogenic factors are implicated as a contributor to the onset and progression of diabetic retinopathy (DR) in type 2 diabetes mellitus patients (T2DM). Tumor necrosis factor (TNF-alpha) and C-reactive protein (CRP) are inflammatory cytokines which induce retinal VEGF and are involved in the progression of proliferative diabetic retinopathy (PDR). Therefore the aim of the present study is to investigate the relationship between diabetic retinopathy and systemic inflammation in patients with type 2 diabetes mellitus. Patients with T2DM, with or without diabetic retinopathy were included in the study. Serum inflammatory cytokines, vascular growth factor were studied in different stages of DR. Patients with T2DM with and without diabetic retinopathy were compared. Patients with diabetic retinopathy had increased serum levels of inflammatory cytokines CRP, TNF-alpha, as well as VEGF compared to serum levels of diabetic patients without retinopathy. T2DM patients with retinopathy have higher levels of circulating inflammatory cytokines and VEGF compared to patients without retinopathy. These proinflammatory cytokines and angiogenic factors are involved in the progression of DR and proliferative diabetic retinopathy. The results showed the importance of inflammation and vascular endothelial growth factor in the progression of NPDR and PDR. Copyright © 2017 Diabetes India. Published by Elsevier Ltd. All rights reserved.

  9. [Prevalence of target organ damage and metabolic abnormalities in resistant hypertension].

    PubMed

    Armario, Pedro; Oliveras, Anna; Hernández Del Rey, Raquel; Ruilope, Luis Miguel; De La Sierra, Alejandro

    2011-10-15

    Patients with resistant hypertension (RH) are relatively frequently visited in specialized units of hypertension. The aim of this study was to assess the prevalence of target organ damage, central obesity and metabolic syndrome in a cohort of patients with RH consecutively included in the Register of Resistant Hypertension of the Spanish Society of Hypertension (SHE-LELHA). Cross-sectional, multicenter epidemiologic study in usual clinical practice conditions. Patients with clinical diagnosis of resistant hypertension, that is, office systolic and diastolic blood pressure ≥ 140 mm Hg and/or ≥ 90 mm Hg, respectively, despite a prescribed therapeutic schedule with an appropriate combination of three or more full-dose antihypertensive drugs, including a diuretic, were consecutively recruited from specialized hypertension units spread through Spain. Demographic and anthropometric characteristics as well as cardiovascular risk factors and associated conditions were recorded, and all the subjects underwent 24-h ambulatory blood pressure monitoring. Left ventricular hypertrophy was considered as a left ventricular mass index ≥ 125 g/m(2) in males and ≥ 110 g/m(2) in females. Left atrial enlargement was defined as an indexed left atrium diameter ≥ 26 mm/m(2). Microalbuminuria was defined as a urinary albumin/creatinine ratio ≥ 22 mg/g in males and ≥ 31 mg/g in females. 513 patients were included, aged 64±11 years old, 47% women. Central obesity was present in 65.7% (CI 95% 61.6-69.9), 38.6% (CI 95% 34.4-42.8) had diabetes and 63.7% (CI 95% 59.4-67.9) had metabolic syndrome. The prevalence of left ventricular hypertrophy and left atrial enlargement, determined by echocardiography was 57.1% (CI 95% 50.8-63.5) and 10.0% (CI 95% 6.3-13.7) respectively. Microalbuminuria was found in 46.6% (CI 95% 41.4-51.8) of the subjects. Patients with metabolic syndrome were significantly older (65.4±11 and 62.5±12 years; P=.0052), presented a higher prevalence of diabetes

  10. Association between albumin:creatinine ratio and 24-hour ambulatory blood pressure in essential hypertension.

    PubMed

    Boulatov, V A; Stenehjem, A; Os, I

    2001-04-01

    Microalbuminuria (MAU) is often found in essential hypertension (EH) and represents a sign of renal and cardiovascular damage. In the present study, we aimed to look at the association between ambulatory blood pressure (BP) and urinary albumin excretion (UAE). We studied 140 patients aged 50.1 +/- 11.6 years referred for 24-h ambulatory blood pressure monitoring (ABPM) and, separately, 46 untreated subjects with newly diagnosed EH. Urinary albumin excretion was evaluated by determination of the albumin-to-creatinine ratio (ACR) in the first voided morning urine sample taken the same day as the ABPM was started. According to the ACR, patients were categorized as having normoalbuminuria (ACR < 1.5 mg/mmol), borderline MAU (1.5 < or = ACR < 3.0 mg/mmol), and overt MAU (ACR > or = 3.0 mg/mmol). Mean ACR was significantly higher in hypertensive than normotensive individuals (2.17 +/- 2.67 mg/mmol and 1.72 +/- 2.97 mg/mmol, respectively, P = .012). Average 24-h, daytime and nighttime systolic BP and diastolic BP were lower in patients with normoalbuminuria than in the other two groups and did not differ among the two microalbuminuric groups. Univariate regression analysis showed a close relationship between ACR and ambulatory BP. Strong correlation between BP and ACR in the normoalbuminuric and borderline microalbuminuric range was also obtained in the group of 46 newly diagnosed hypertensive patients. In conclusion, the threshold level of ACR > or = 3.0 mg/mmol currently used to define microalbuminuria may be not applicable to EH. Instead, a threshold level of ACR > or = 1. 5 mg/mmol may be more appropriate.

  11. Hypertensive Emergencies in Pregnancy.

    PubMed

    Olson-Chen, Courtney; Seligman, Neil S

    2016-01-01

    The prevalence of hypertensive disorders in pregnancy is increasing. The etiology and pathophysiology of hypertensive disorders in pregnancy remain poorly understood. Hypertensive disorders are a major cause of maternal and perinatal morbidity and mortality. Treatment of hypertension decreases the incidence of severe hypertension, but it does not impact rates of preeclampsia or other pregnancy complications. Several antihypertensive medications are commonly used in pregnancy, although there is a lack of randomized controlled trials. Severe hypertension should be treated immediately to prevent maternal end-organ damage. Appropriate antepartum, intrapartum, and postpartum management is important in caring for patients with hypertensive disorders.

  12. Frequency of Evidence-Based Screening for Retinopathy in Type 1 Diabetes.

    PubMed

    Nathan, David M; Bebu, Ionut; Hainsworth, Dean; Klein, Ronald; Tamborlane, William; Lorenzi, Gayle; Gubitosi-Klug, Rose; Lachin, John M

    2017-04-20

    In patients who have had type 1 diabetes for 5 years, current recommendations regarding screening for diabetic retinopathy include annual dilated retinal examinations to detect proliferative retinopathy or clinically significant macular edema, both of which require timely intervention to preserve vision. During 30 years of the Diabetes Control and Complications Trial (DCCT) and its longitudinal follow-up Epidemiology of Diabetes Interventions and Complications (EDIC) study, retinal photography was performed at intervals of 6 months to 4 years. We used retinal photographs from the DCCT/EDIC study to develop a rational screening frequency for retinopathy. Markov modeling was used to determine the likelihood of progression to proliferative diabetic retinopathy or clinically significant macular edema in patients with various initial retinopathy levels (no retinopathy or mild, moderate, or severe nonproliferative diabetic retinopathy). The models included recognized risk factors for progression of retinopathy. Overall, the probability of progression to proliferative diabetic retinopathy or clinically significant macular edema was limited to approximately 5% between retinal screening examinations at 4 years among patients who had no retinopathy, 3 years among those with mild retinopathy, 6 months among those with moderate retinopathy, and 3 months among those with severe nonproliferative diabetic retinopathy. The risk of progression was also closely related to mean glycated hemoglobin levels. The risk of progression from no retinopathy to proliferative diabetic retinopathy or clinically significant macular edema was 1.0% over 5 years among patients with a glycated hemoglobin level of 6%, as compared with 4.3% over 3 years among patients with a glycated hemoglobin level of 10%. Over a 20-year period, the frequency of eye examinations was 58% lower with our practical, evidence-based schedule than with routine annual examinations, which resulted in substantial cost savings

  13. Vibration perception threshold for sight-threatening retinopathy screening in type 2 diabetic outpatients.

    PubMed

    Shen, Jing; Hu, Yanyun; Liu, Fang; Zeng, Hui; Li, Lianxi; Zhao, Jun; Zhao, Jungong; Zheng, Taishan; Lu, Huijuan; Lu, Fengdi; Bao, Yuqian; Jia, Weiping

    2013-10-01

    We investigated the relationship between vibration perception threshold and diabetic retinopathy and verified the screening value of vibration perception threshold for severe diabetic retinopathy. A total of 955 patients with type 2 diabetes were recruited and divided into three groups according to their fundus oculi photography results: no diabetic retinopathy (n = 654, 68.48%), non-sight-threatening diabetic retinopathy (n = 189, 19.79%) and sight-threatening diabetic retinopathy (n = 112, 11.73%). Their clinical and biochemical characteristics, vibration perception threshold and the diabetic retinopathy grades were detected and compared. There were significant differences in diabetes duration and blood glucose levels among three groups (all p < 0.05). The values of vibration perception threshold increased with the rising severity of retinopathy, and the vibration perception threshold level of sight-threatening diabetic retinopathy group was significantly higher than both non-sight-threatening diabetic retinopathy and no diabetic retinopathy groups (both p < 0.01). The prevalence of sight-threatening diabetic retinopathy in vibration perception threshold >25 V group was significantly higher than those in 16-24 V group (p < 0.01). The severity of diabetic retinopathy was positively associated with diabetes duration, blood glucose indexes and vibration perception threshold (all p < 0.01). Multiple stepwise regression analysis proved that glycosylated haemoglobin (β = 0.385, p = 0.000), diabetes duration (β = 0.275, p = 0.000) and vibration perception threshold (β = 0.180, p = 0.015) were independent risk factors for diabetic retinopathy. Receiver operating characteristic analysis further revealed that vibration perception threshold higher than 18 V was the optimal cut point for reflecting high risk of sight-threatening diabetic retinopathy (odds ratio = 4.20, 95% confidence interval = 2.67-6.59). There was a close association between vibration perception

  14. Retinopathy and Progression of CKD: The CRIC Study

    PubMed Central

    Pistilli, Maxwell; Ying, Gui-Shuang; Daniel, Ebenezer; Maguire, Maureen G.; Xie, Dawei; Whittock-Martin, Revell; Parker Ostroff, Candace; Lo, Joan C.; Townsend, Raymond R.; Gadegbeku, Crystal A.; Lash, James P.; Fink, Jeffrey C.; Rahman, Mahboob; Feldman, Harold I.; Kusek, John W.

    2014-01-01

    Background and objectives Retinal abnormalities may be associated with changes in the renal vasculature. This study assessed the association between retinopathy and progression of kidney disease in participants of the Chronic Renal Insufficiency Cohort (CRIC) study. Design, setting, participants, & measurements This was a prospective study in which patients with CKD enrolled in CRIC had nonmydriatic fundus photographs of both eyes. All CRIC participants in six clinical sites in which fundus cameras were deployed were offered participation. Photographs were reviewed at a reading center. The presence and severity of retinopathy and vessel calibers were assessed using standard protocols by graders masked to clinical information. The associations of retinal features with changes in eGFR and the need for RRT (ESRD) were assessed. Results Retinal images and renal progression outcomes were obtained from 1852 of the 2605 participants (71.1%) approached. During follow-up (median 2.3 years), 152 participants (8.2%) developed ESRD. Presence and severity of retinopathy at baseline were strongly associated with the risk of subsequent progression to ESRD and reductions in eGFR in unadjusted analyses. For example, participants with retinopathy were 4.4 times (95% confidence interval [95% CI], 3.12 to 6.31) more likely to develop ESRD than those without retinopathy (P<0.001). However, this association was not statistically significant after adjustment for initial eGFR and 24-hour proteinuria. Venular and arteriolar diameter calibers were not associated with ESRD or eGFR decline. The results showed a nonlinear relationship between mean ratio of arteriole/vein calibers and the risk of progression to ESRD; participants within the fourth arteriole/vein ratio quartile were 3.11 times (95% CI, 1.51 to 6.40) more likely to develop ESRD than those in the first quartile (P<0.001). Conclusions The presence and severity of retinopathy were not associated with ESRD and decline in eGFR after

  15. [Hypertensive crisis: urgency and hypertensive emergency].

    PubMed

    Sobrino Martínez, Javier; Doménech Feria-Carot, Mónica; Morales Salinas, Alberto; Coca Payeras, Antonia

    2016-11-18

    Hypertensive crises lumped several clinical situations with different seriousness and prognosis. The differences between hypertensive urgency and hypertensive emergency depends on if this situation involves a vital risk for the patient. This risk is defined more by the severity of the organ damage than for the higher values of blood pressure. The hypertensive urgency not involves an immediately risk for the patient, for these reason, the treatment can be completed after discharged. Otherwise, the hypertensive emergency is a critical clinical condition that requires hospital assistance. Faced with a patient, with severe hypertension, asymptomatic or with unspecific symptoms we must be careful. First, we need to confirm the values of blood pressure, with several measures of blood pressure and investigate and treat factors, which triggered this situation. The objective of medical treatment for hypertensive urgency is to reduce blood pressure values (at least 20% of baseline values) but to avoid sudden reduction of these values. In hypertensive urgencies rapid acting drug should not be used because of the risk of ischemic stroke and use drugs with longer half-life. The cardiovascular risk of these patients is higher than that do not suffer hypertensive crisis. The treatment must be personalized in each hypertensive emergency and intravenous it’s the best route to treat these patients.

  16. Long-term effects of Irbesartan treatment and smoking on nucleic acid oxidation in patients with type 2 diabetes and microalbuminuria: an Irbesartan in patients with type 2 diabetes and Microalbuminuria (IRMA 2) substudy.

    PubMed

    Broedbaek, Kasper; Henriksen, Trine; Weimann, Allan; Petersen, Morten; Andersen, Jon T; Afzal, Shoaib; Jimenez-Solem, Espen; Persson, Frederik; Parving, Hans-Henrik; Rossing, Peter; Poulsen, Henrik E

    2011-05-01

    We tested whether long-term treatment with the angiotensin II receptor antagonist irbesartan reduces nucleic acid oxidation in patients with type 2 diabetes and microalbuminuria. The Irbesartan in Patients With Type 2 Diabetes and Microalbuminuria (IRMA 2) study was a 2-year multicenter randomized double-blind trial comparing irbesartan (150 and 300 mg once daily) with placebo. We studied a subgroup of 50 patients where urine samples were available for analysis of albumin and the oxidatively modified guanine nucleosides 8-oxo-7,8-dihydro-2'-deoxyguanosine (8-oxodG) and 8-oxo-7,8-dihydroguanosine (8-oxoGuo). During the 2-year trial, no significant differences in 8-oxodG and 8-oxoGuo excretions between placebo and irbesartan treatment were seen. 8-oxodG and albumin excretion decreased with time (P = 0.0004 and P < 0.0001, respectively), whereas treatment-related differences were shown for albumin excretion (P = 0.0008) only, as previously reported. Important secondary findings were significant associations between changes in 8-oxodG excretion and changes in albumin excretion and glycated hemoglobin (HbA(1c)). During the study period, 8-oxodG excretion decreased by 3 and 26% in smokers and nonsmokers, respectively (P = 0.015), and urinary albumin excretion decreased 22% in smokers and 58% in nonsmokers (P = 0.011). Irbesartan treatment was not significantly more effective than placebo in reducing nucleic acid oxidation. The results indicate that DNA oxidation in diabetes patients is reduced by various components in the treatment of diabetes where glycemic control seems to be important and addition of angiotensin II receptor antagonists does not lead to any substantial additional reduction. Furthermore, the reductions in DNA oxidation and albumin excretion seem to be counteracted by smoking.

  17. Helicobacter pylori infection and pepsinogen levels have clinical significance in hypertension patients

    PubMed Central

    Lu, Changqing; Jia, Helei; Xu, Aiguo; Tang, Jianming; Xu, Gang; Yue, Wenbin; Zhang, Junjie

    2014-01-01

    Helicobacter pylori (Hp) infection is known to alter levels of pepsinogens (PG) and is correlated with several disease states, including gastric and cardiovascular diseases. This study sought to assess whether Hp infection is associated with hypertension as well as to identify the value of assessing the PG I/PG II ratio in patients with hypertension. The study included 396 individuals with hypertension who were assessed for infection with Hp by colloidal gold assay. Participants’ weight, height, blood pressure, and serum lipids were measured, and participants were examined for the presence of renal or ocular damage. H. pylori infection status or PG I/PG II ratio were compared against other variables (e.g., body mass index, serum cholesterol, diastolic blood pressure) by t-test or ⇨2 test, and Pearson’s correlation analysis was used to identify associations. Consistent with other studies, the PG I/PG II ratio of patients with Hp infection was significantly lower than that of patients without Hp infection (P < 0.001). The serum total cholesterol and triglycerides of patients with Hp infection were significantly higher than those of patients without Hp infection (P < 0.001), and the PG I/PG II ratio was negatively correlated with total cholesterol (r=-0.61) and triglycerides (r=-0.56) levels. However, there was no significant difference in hypertension severity by Hp infection status or PG I/PG II ratio. Interestingly, the PG I/PG II ratio was significantly lower in patients with hypertensive nephropathy or hypertensive retinopathy than in patients without these symptoms (P < 0.05). The areas under the receiver-operating characteristic curve were 0.77 and 0.83 in the diagnosis of nephropathy and retinopathy, respectively. These findings indicate that the PG I/PG II ratio is lower in individuals with hypertensive nephropathy and hypertensive retinopathy. Thus, the detection of the PG I/PG II ratio may be valuable for diagnostic screening for hypertensive organ

  18. Plasma Cardiotrophin-1 as a Marker of Hypertension and Diabetes-Induced Target Organ Damage and Cardiovascular Risk

    PubMed Central

    Gamella-Pozuelo, Luis; Fuentes-Calvo, Isabel; Gómez-Marcos, Manuel A.; Recio-Rodriguez, José I.; Agudo-Conde, Cristina; Fernández-Martín, José L.; Cannata-Andía, Jorge B.; López-Novoa, José M.; García-Ortiz, Luis; Martínez-Salgado, Carlos

    2015-01-01

    Abstract The search for biomarkers of hypertension and diabetes-induced damage to multiple target organs is a priority. We analyzed the correlation between plasma cardiotrophin-1 (CT-1), a chemokine that participates in cardiovascular remodeling and organ fibrosis, and a wide range of parameters currently used to diagnose morphological and functional progressive injury in left ventricle, arteries, and kidneys of diabetic and hypertensive patients, in order to validate plasma levels of CT-1 as clinical biomarker. This is an observational study with 93 type 2-diabetic patients, 209 hypertensive patients, and 82 healthy controls in which we assessed the following parameters: plasma CT-1, basal glycaemia, systolic blood pressure (SBP), diastolic blood pressure (DBP), pulse pressure (PP), left ventricular hypertrophy (LVH by electrocardiographic indexes), peripheral vascular disease (by pulse wave velocity—PWV, carotid intima-media thickness—C-IMT, and ankle-brachial index—ABI), and renal impairment (by microalbuminuria, albumin/creatinine urinary ratio, plasma creatinine concentrations, and glomerular filtration rate). Hypertensive or diabetic patients have higher plasma CT-1 than control patients. CT-1 positively correlates with basal glycaemia, SBP, DBP, PP, LVH, arterial damage (increased IMT, decreased ABI), and early renal damage (microalbuminuria, elevated albumin/creatinine ratio). CT-1 also correlates with increased 10-year cardiovascular risk. Multiple linear regression analysis confirmed that CT-1 was associated with arterial injury assessed by PWV, IMT, ABI, and cardiac damage evaluated by Cornell voltage duration product. Increases in plasma CT-1 are strongly related to the intensity of several parameters associated to target organ damage supporting further investigation of its diagnostic capacity as single biomarker of cardiovascular injury and risk and, possibly, of subclinical renal damage. PMID:26222851

  19. Plasma Cardiotrophin-1 as a Marker of Hypertension and Diabetes-Induced Target Organ Damage and Cardiovascular Risk.

    PubMed

    Gamella-Pozuelo, Luis; Fuentes-Calvo, Isabel; Gómez-Marcos, Manuel A; Recio-Rodriguez, José I; Agudo-Conde, Cristina; Fernández-Martín, José L; Cannata-Andía, Jorge B; López-Novoa, José M; García-Ortiz, Luis; Martínez-Salgado, Carlos

    2015-07-01

    The search for biomarkers of hypertension and diabetes-induced damage to multiple target organs is a priority. We analyzed the correlation between plasma cardiotrophin-1 (CT-1), a chemokine that participates in cardiovascular remodeling and organ fibrosis, and a wide range of parameters currently used to diagnose morphological and functional progressive injury in left ventricle, arteries, and kidneys of diabetic and hypertensive patients, in order to validate plasma levels of CT-1 as clinical biomarker.This is an observational study with 93 type 2-diabetic patients, 209 hypertensive patients, and 82 healthy controls in which we assessed the following parameters: plasma CT-1, basal glycaemia, systolic blood pressure (SBP), diastolic blood pressure (DBP), pulse pressure (PP), left ventricular hypertrophy (LVH by electrocardiographic indexes), peripheral vascular disease (by pulse wave velocity-PWV, carotid intima-media thickness-C-IMT, and ankle-brachial index-ABI), and renal impairment (by microalbuminuria, albumin/creatinine urinary ratio, plasma creatinine concentrations, and glomerular filtration rate).Hypertensive or diabetic patients have higher plasma CT-1 than control patients. CT-1 positively correlates with basal glycaemia, SBP, DBP, PP, LVH, arterial damage (increased IMT, decreased ABI), and early renal damage (microalbuminuria, elevated albumin/creatinine ratio). CT-1 also correlates with increased 10-year cardiovascular risk. Multiple linear regression analysis confirmed that CT-1 was associated with arterial injury assessed by PWV, IMT, ABI, and cardiac damage evaluated by Cornell voltage duration product.Increases in plasma CT-1 are strongly related to the intensity of several parameters associated to target organ damage supporting further investigation of its diagnostic capacity as single biomarker of cardiovascular injury and risk and, possibly, of subclinical renal damage.

  20. [French as 2005-recommendations on the management of arterial hypertension].

    PubMed

    Chamontin, B; Halimi, J M

    2007-01-01

    Self blood pressure measurements (home BP) and/or ambulatory BP measurements are recommended in mild to moderate hypertension (140/90 - 179/109 mmHg) in order to confirm sustained hypertension and identify white coat and masked hypertension. The evaluation of target organ damages (TOD) has to be integrated in cardiovascular risk estimate and taken into account in the management of hypertensive patients. Beside echocardiography, there is a place for the screening of microalbuminuria in non diabetic hypertensive patients, but these investigations should not be performed systematically. Arterial stiffness evaluation and carotid intima-media thickness quantification are not yet recommended. Cardiovascular risk (CV risk) estimate plays a pivotal role in the therapeutic decision and strategy. The cardiovascular risk grade is based on [1] the list of cardiovascular risk factors (same list AFSSAPS recommendations on dyslipidemia), [2] the presence or absence of TOD and [3] cardiovascular complications: "low", "medium", and "high" CV risk. Lifestyle modifications are recommended in all hypertensive patients. Five antihypertensive drugs are recommended for first line therapy: beta-blockers, thiazide diuretics, ACEIs, ARA II and CCBs (and fixed low dose combinations with AFSSAPS agreement for first line). In order to initiate the treatment, Evidence-based therapy (according to clinical trials conducted in different clinical situations), certain comorbid conditions (compelling indications), efficacy and side-effects in a previous experience, and the cost are the determinants of the first choice. Most hypertensive patients require more than one agent to achieve target blood pressure and for second line therapy the recommended combinations are: betablockers-diuretics, ACEIs-diuretics, ARAII-diuretics, betablockers-CCBs (DHP), ACEIs-CCBs, ARA II-CCBs and CCBs-diuretics. The delay to establish a combination therapy depend on CV risk. The BP goals are those recommended by ESH

  1. [Hypertensive emergencies and urgencies].

    PubMed

    Phan, David Giang; Dreyfuss-Tubiana, Céline; Blacher, Jacques

    2015-01-01

    Hypertension is a common disease, the most common chronic disease. Hypertensive emergency is much less frequent and only affects 1 to 2 % of all hypertensive patients. The true hypertensive emergency is characterized by the serious damage of one hypertensive target organ and requires an urgent intravenous treatment. Isolated blood pressure elevation should not be regarded as a hypertensive emergency if there is no target organ damage, even if the blood pressure is very high. These situations of "false hypertensive emergency", or hypertensive urgencies, often requires an immediate treatment, but oral. Signs of visceral pain of true hypertensive emergency often are a poor general condition, severe headache, decreased visual acuity, neurological deficit of ischemic or hemorrhagic cause, confusion, dyspnea with orthopnoea revealing heart failure, angina, chest pain revealing an aortic dissection, proteinuria, acute renal failure or eclampsia. True hypertensive emergencies include several entities, namely: severe hypertension, malignant hypertension and accelerated hypertension. If malignant hypertension is not treated, the prognosis is poor with 50 % death risk in the following year. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  2. Resistant hypertension and the Birmingham Hypertension Square.

    PubMed

    Felmeden, D C; Lip, G Y

    2001-06-01

    Recent guidelines for the treatment of hypertension place great emphasis on tighter blood pressure control, especially in the presence of hypertensive target organ damage and diabetes. In order to achieve these treatment targets, more patients will require a combination of antihypertensive medications. However, resistant hypertension may have many possible underlying causes, and clinicians should appreciate how to detect and tackle these potential problems. Effective and synergistic combinations are therefore of vital importance, especially in patients with resistant hypertension. The choice of rational first- and second-line drugs that act in synergy could lead to better blood pressure management as well as significant financial savings for health care resources. The use of the Birmingham Hypertension Square for the optimum choice of add-in drugs for the treatment of resistant hypertension may aid management.

  3. Is there any effect of bolus and/or infusion 5-fluorouracil treatment on microalbuminuria in immediate or long term?

    PubMed

    Tanriverdi, Ozgur

    2014-07-01

    5-Fluorouracil is a widely used cytotoxic chemotherapeutic agent in the treatment settings particularly in patients with gastrointestinal cancer. Various studies on the cardiac adverse effects of 5-fluorouracil, reported the likelihood of altered myocardial contractility and vascular endothelial damage caused by this agent. However, the mechanism underlying 5-fluorouracil-related cardiotoxicity is not clear. In certain experimental studies, thrombotic processes occurring in microvascular field were supposed to play a role in this condition. In the light of this knowledge, the administration of 5-fluorouracil may be considered to cause renal vascular endothelial damage that may result in the altered endothelial permeability. As a result of endothelial dysfunction, increased urinary albumin excretion may be in question and no study investigating this potential direct relationship has been available in medical literature. Based on this evidence, the hypothesis of that 5-fluorouracil might cause renal vascular dysfunction and microalbuminuria, was discussed in this article along with the basic knowledge.

  4. Using a patient image archive to diagnose retinopathy

    SciTech Connect

    Tobin Jr, Kenneth William; Abramoff, M.D.; Chaum, Edward; Giancardo, Luca; Govindaswamy, Priya; Karnowski, Thomas Paul; Tennant, M; Swainson, Stephen

    2008-01-01

    Diabetes has become an epidemic that is expected to impact 365 million people worldwide by 2025. Consequently, diabetic retinopathy is the leading cause of blindness in the industrialized world today. If detected early, treatments can preserve vision and significantly reduce debilitating blindness. Through this research we are developing and testing a method for automating the diagnosis of retinopathy in a screening environment using a patient archive and digital fundus imagery. We present an overview of our content-based image retrieval (CBIR) approach and provide performance results for a dataset of 98 images from a study in Canada when compared to an archive of 1,355 patients from a study in the Netherlands. An aggregate performance of 89% correct diagnosis is achieved, demonstrating the potential of automated, web-based diagnosis for a broad range of imagery collected under different conditions and with different cameras.

  5. Canine multifocal retinopathy in the Australian Shepherd: a case report

    PubMed Central

    Hoffmann, Ingo; Guziewicz, Karina E.; Zangerl, Barbara; Aguirre, Gustavo D.; Mardin, Christian Y.

    2013-01-01

    A 1-year-old Australian Shepherd (AS) was presented for a routine hereditary eye examination. During the examination multiple raised, brown to orange lesions were noted in the fundus, which could not be attributed to a known retinal disease in this breed. As they clinically most closely resembled canine multifocal retinopathy (cmr) and no indication of an acquired condition was found, genetic tests for BEST1 gene mutations were performed. These showed the dog to be homozygous for the cmr1 (C73T/R25X) gene defect. Furthermore, ultrasound (US), electroretinography (ERG), and optical coherence tomography were performed, confirming changes typical for cmr. Subsequently, the AS pedigree members were genetically and clinically tested, demonstrating autosomal recessive inheritance with no clinical symptoms in carrier animals, as was previously described for cmr. To our knowledge, this is the first reported case of canine multifocal retinopathy in the AS breed. Further investigations are under way. PMID:22432598

  6. Chinese herbal drugs for the treatment of diabetic retinopathy.

    PubMed

    Behl, Tapan; Kotwani, Anita

    2017-03-01

    To explore the various pharmacological actions and the molecular mechanisms behind them by which Chinese herbs tend to lower the risk of developing microvascular diabetic complications in retina and prevent its further progression. Several Chinese herbs, indeed, elicit potent anti-inflammatory, antioxidant, anti-angiogenic, anti-apoptotic, peroxisome proliferator-activated receptor-gamma receptor agonistic, platelet-activating factor antagonistic, aldose reductase inhibitory and various other beneficial pharmacological activities, required to counteract the pathological conditions prevalent in retina during diabetes. Chinese herbs can potentially be used for the treatment/prevention of diabetic retinopathy owing to the virtue of numerous properties by which they alleviate several hyperglycaemia-induced pathological occurrences in retina. This would provide a natural and safe therapy for diabetic retinopathy, which currently is clinically limited to destructive techniques like laser photocoagulation and vitrectomy. © 2017 Royal Pharmaceutical Society.

  7. A case of recurrent, self-inflicted handheld laser retinopathy.

    PubMed

    Simonett, Joseph M; Scarinci, Fabio; Labriola, Leanne T; Jampol, Lee M; Goldstein, Debra A; Fawzi, Amani A

    2016-04-01

    A 17-year-old young man presented with vision loss and discrete, bilateral foveal lesions. The patient returned 6 weeks later with worsening vision, prominent bilateral retinal lesions, and a full-thickness macular hole in the right eye consistent with recurrent self-inflicted handheld laser retinopathy. After instructing the family to remove the patient's access to laser pointers, follow-up examination revealed spontaneous closure of the macular hole but minimal vision improvement. Recurrent ocular exposure to handheld lasers can masquerade as an organic process in patients who withhold pertinent history. Clinicians should rely on the distinguishing features seen on examination and multimodal imaging to make the diagnosis of handheld laser retinopathy.

  8. Unilateral Purtscher-like retinopathy after weight-lifting.

    PubMed

    Kocak, N; Kaynak, S; Kaynak, T; Oner, H F; Cingil, G

    2003-05-01

    To report a case of Purtscher-like retinopathy after weightlifting. A 17-year-old man presented with a sudden visual loss in his left eye after weightlifting two weeks ago. Fundus examination of the left eye showed cotton-wool spots and scattered retinal hemorrhages in the posterior pole. Fluorescein angiography and indocyanine green angiography with a scanning laser ophthalmoscope were performed. Angiography showed hypofluorescent areas adjacent to the optic disc and in the posterior pole and partial filling insufficiency in the inferior and inferotemporal branch retinal veins. Complete venous filling was noted in late phases of angiography. The pathogenesis of weightlifting suggests the Purtscher-like changes as a result of Valsalva maneuver in our case. To our knowledge, this is the first reported case of Purtscher-like retinopathy associated with weightlifting.

  9. Biomarkers in Diabetic Retinopathy and the Therapeutic Implications

    PubMed Central

    Zorena, Katarzyna; Raczyńska, Dorota; Raczyńska, Krystyna

    2013-01-01

    The main problem both in type 1 (T1DM) and type 2 (T2DM) diabetes is the development of chronic vascular complications encompassing micro- as well as macrocirculation. Chronic complications lower the quality of life, lead to disability, and are the cause of premature death in DM patients. One of the chronic vascular complications is a diabetic retinopathy (DR) which leads to a complete loss of sight in DM patients. Recent trials show that the primary cause of diabetic retinopathy is retinal neovascularization caused by disequilibrium between pro- and antiangiogenic factors. Gaining knowledge of the mechanisms of action of factors influencing retinal neovascularization as well as the search for new, effective treatment methods, especially in advanced stages of DR, puts special importance on research concentrating on the implementation of biological drugs in DR therapy. At present, it is antivascular endothelial growth factor and antitumor necrosis factor that gain particular significance. PMID:24311895

  10. Melanoma associated retinopathy: A new dimension using adaptive optics.

    PubMed

    Dabir, Supriya; Mangalesh, Shwetha; Govindraj, Indu; Mallipatna, Ashwin; Battu, Rajani; Shetty, Rohit

    2015-01-01

    We report a 56-year-old male patient, complaining of metamorphopsia in his left eye nevertheless visual acuity, slit lamp, and fundus examinations were within normal limits. Microperimetry (MAIA, Centervue, Italy) revealed central field loss and spectral domain optical coherence tomography (Spectralis, Heidelberg, Germany) showed disrupted cone outer segment tip layer. The patient had a diagnosis of cutaneous melanoma in his foot for which an excision biopsy with lymph node dissection was performed 5 months earlier. Our clinical diagnosis was melanoma-associated retinopathy. Electrophysiology confirmed the diagnosis. Adaptive optics retinal imaging (Imagine eyes, Orsay) was performed to assess the cone mosaic integrity across the central retina. This is the first report on the investigation of autoimmune retinopathy using adaptive optics ophthalmoscopy. This case highlights the viability of innovative diagnostic modalities that aid early detection and subsequent management of vision threatening retinal.

  11. Neodymium-YAG laser vitreolysis in sickle cell retinopathy

    SciTech Connect

    Hrisomalos, N.F.; Jampol, L.M.; Moriarty, B.J.; Serjeant, G.; Acheson, R.; Goldberg, M.F.

    1987-08-01

    Six patients with proliferative sickle cell retinopathy and vitreous bands were treated with the neodymium-YAG (Nd-YAG) laser to accomplish lysis of avascular traction bands or to clear the media in front of the macula. Transection of bands was possible in five of the six cases but in two of these the effect was only partial. Three cases were satisfactorily treated with the Nd-YAG laser application alone, two eventually required conventional vitreoretinal surgery, and one patient's condition stabilized despite failure of the treatment. Complications from the treatment occurred in three cases and included subretinal (choroidal) hemorrhage, preretinal hemorrhage, microperforation of a retinal vein, and focal areas of damage to the retinal pigment epithelium. Neodymium-YAG vitreolysis may be a useful modality in carefully selected patients with proliferative sickle cell retinopathy, but potentially sight-threatening complications may occur.

  12. [Pulse pressure as a prognostic indicator of organ damage in patients with essential hypertension].

    PubMed

    Jołda-Mydłowska, Beata; Kobusiak-Prokopowicz, Małgorzata; Sławuta, Agnieszka; Witkowska, Maria

    2004-05-01

    Pulse pressure (PP), defined as systolic blood pressure minus diastolic blood pressure, plays an important role as a risk factor for cardiovascular events. Pulse pressure is pulsatile component of blood pressure. A widened pulse pressure reflects increased stiffness of the large arteries. The aim of the study was to evaluate the association between pulse pressure and organ damage in essential hypertension. We examined 60 subjects, 34 women aged 59 +/- 13 years and 26 men aged 48 +/- 17 years with primary hypertension. In every subject we performed 24-hour automatic blood pressure measurement and echocardiography, abdominal ultrasonography, funduscopy, chest x-ray. We measured sodium potassium, creatinine level in serum and in urine, creatinine clearance and microalbuminuria. Pulse pressure is proportional to the stage of hypertension. A dimension of the aorta parallels with measures of blood pressure. The strong correlation between pulse pressure and damage in funduscopy can indicate, that complication in fundus of the eye are dependent more than the level of a pressure. The significantly higher sodium level in serum and the positive correlation between natremia, natriuresis and pulse pressure proves the role of natrium in pathophysiology of hypertension.

  13. The United Kingdom Diabetic Retinopathy Electronic Medical Record Users Group: Report 3: Baseline Retinopathy and Clinical Features Predict Progression of Diabetic Retinopathy.

    PubMed

    Lee, Cecilia S; Lee, Aaron Y; Baughman, Douglas; Sim, Dawn; Akelere, Toks; Brand, Christopher; Crabb, David P; Denniston, Alastair K; Downey, Louise; Fitt, Alan; Khan, Rehna; Mahmood, Sajad; Mandal, Kaveri; Mckibbin, Martin; Menon, Geeta; Lobo, Aires; Kumar, B Vineeth; Natha, Salim; Varma, Atul; Wilkinson, Elizabeth; Mitry, Danny; Bailey, Clare; Chakravarthy, Usha; Tufail, Adnan; Egan, Catherine

    2017-08-01

    To determine the time and risk factors for developing proliferative diabetic retinopathy (PDR) and vitreous hemorrhage (VH). Multicenter, national cohort study. Anonymized data of 50 254 patient eyes with diabetes mellitus at 19 UK hospital eye services were extracted at the initial and follow-up visits between 2007 and 2014. Time to progression of PDR and VH were calculated with Cox regression after stratifying by baseline diabetic retinopathy (DR) severity and adjusting for age, sex, race, and starting visual acuity. Progression to PDR in 5 years differed by baseline DR: no DR (2.2%), mild (13.0%), moderate (27.2%), severe nonproliferative diabetic retinopathy (NPDR) (45.5%). Similarly, 5-year progression to VH varied by baseline DR: no DR (1.1%), mild (2.9%), moderate (7.3%), severe NPDR (9.8%). Compared with no DR, the patient eyes that presented with mild, moderate, and severe NPDR were 6.71, 14.80, and 28.19 times more likely to develop PDR, respectively. In comparison to no DR, the eyes with mild, moderate, and severe NPDR were 2.56, 5.60, and 7.29 times more likely to develop VH, respectively. In severe NPDR, the eyes with intraretinal microvascular abnormalities (IRMA) had a significantly increased hazard ratio (HR) of developing PDR (HR 1.77, 95% confidence interval [CI] 1.25-2.49, P = .0013) compared with those with venous beading, whereas those with 4-quadrant dot-blot hemorrhages (4Q DBH) had 3.84 higher HR of developing VH (95% CI 1.39-10.62, P = .0095). Baseline severities and features of initial DR are prognostic for PDR development. IRMA increases risk of PDR whereas 4Q DBH increases risk of VH. Published by Elsevier Inc.

  14. Vitamin Status as a Determinant of Serum Homocysteine Concentration in Type 2 Diabetic Retinopathy

    PubMed Central

    Raptis, Athanasios; Apergis, George; Dimitriadis, George; Vergados, Ioannis; Theodossiadis, Panagiotis

    2014-01-01

    We investigated the association of serum homocysteine levels and vitamin status with type 2 diabetic retinopathy. This study included 65 patients with and 75 patients without diabetic retinopathy. Patients with diabetic retinopathy had significantly higher serum homocysteine levels (P < 0.001), higher prevalence of hyperhomocysteinemia (P < 0.001), lower serum folic acid (P < 0.001), and vitamin B12 (P = 0.014) levels than those without diabetic retinopathy. Regression analysis revealed that homocysteine was an independent risk factor for diabetic retinopathy and there was a threshold in its serum level (13.7 μmol/L), above which the risk of diabetic retinopathy greatly increases (OR = 1.66, P = 0.001). Folic acid was associated with decreased odds for diabetic retinopathy (OR = 0.73, P < 0.001). There was a threshold in serum vitamin B12 level (248.4 pg/mL), below which serum homocysteine concentration significantly increases with decreasing serum vitamin B12 (P = 0.003). Our findings suggest that hyperhomocysteinemia is an independent risk factor for the development and progression of diabetic retinopathy. Decreased serum levels of folic acid and vitamin B12, through raising serum homocysteine concentrations, may also affect the diabetic retinopathy risk. PMID:25006590

  15. Necrotising herpetic retinopathies: a review and progressive outer retinal necrosis case report.

    PubMed

    Ittner, Erica A; Bhakhri, Raman; Newman, Tricia

    2016-01-01

    Necrotising retinopathies can be visually devastating. Most often associated with the viral family Herpesviridae and seen in both immune-competent and immunocompromised hosts, possible complications of necrotising retinopathies include progressive retinal necrosis with or without macular involvement, optic neuropathy and ultimately, secondary retinal detachment. Examples include progressive outer retinal necrosis, acute retinal necrosis and cytomegaloviral retinitis. If diagnosed early and treated aggressively, visual complications can be prevented; however, there is no current consensus on the most appropriate antiviral regimen for each of the different varieties of necrotising herpetic retinopathy. This paper reviews aspects of varieties of necrotising herpetic retinopathy, including pathophysiology, treatment and diagnostic testing. © 2016 Optometry Australia.

  16. Diabetic retinopathy: reversibility of epigenetic modifications and new therapeutic targets.

    PubMed

    Zhang, Xinyuan; Zhao, Lin; Hambly, Brett; Bao, Shisan; Wang, Kaiyue

    2017-01-01

    In recent years, considerable progress has been made in the molecular mechanisms of epigenetics in disease development and progression, the reversible characteristics of epigenetic modification provide new insights for the treatment of such diseases. The pathogenesis of diabetic retinopathy (DR) has not yet been fully understood, treatment of refractory and recurrent diabetic macular edema remains a big change in clinical practice. This review emphasizes that reversibility of epigenetic modification could provide a new strategy for the prevention and treatment of diseases.

  17. Near-infrared fundus autoflorescence imaging in solar retinopathy

    PubMed Central

    Czepita, Maciej; Machalińska, Anna; Czepita, Damian

    2017-01-01

    Solar retinopathy is a rare clinical entity caused by photochemical damage to the retinal pigment epithelium layer and photoreceptors of the fovea. Here we describe a case of a 33-year-old female patient diagnosed by near-infrared fundus autofluorescence imaging for signs of damage to the melanosomes of the retinal pigment epithelium of the fovea. The patient was advised to discontinue looking at the sun with the naked eye. PMID:28293534

  18. Association between plasma triglycerides and high-density lipoprotein cholesterol and microvascular kidney disease and retinopathy in type 2 diabetes mellitus: a global case-control study in 13 countries.

    PubMed

    Sacks, Frank M; Hermans, Michel P; Fioretto, Paola; Valensi, Paul; Davis, Timothy; Horton, Edward; Wanner, Christoph; Al-Rubeaan, Khalid; Aronson, Ronnie; Barzon, Isabella; Bishop, Louise; Bonora, Enzo; Bunnag, Pongamorn; Chuang, Lee-Ming; Deerochanawong, Chaicharn; Goldenberg, Ronald; Harshfield, Benjamin; Hernández, Cristina; Herzlinger-Botein, Susan; Itoh, Hiroshi; Jia, Weiping; Jiang, Yi-Der; Kadowaki, Takashi; Laranjo, Nancy; Leiter, Lawrence; Miwa, Takashi; Odawara, Masato; Ohashi, Ken; Ohno, Atsushi; Pan, Changyu; Pan, Jiemin; Pedro-Botet, Juan; Reiner, Zeljko; Rotella, Carlo Maria; Simo, Rafael; Tanaka, Masami; Tedeschi-Reiner, Eugenia; Twum-Barima, David; Zoppini, Giacomo; Carey, Vincent J

    2014-03-04

    Microvascular renal and retinal diseases are common major complications of type 2 diabetes mellitus. The relation between plasma lipids and microvascular disease is not well established. The case subjects were 2535 patients with type 2 diabetes mellitus with an average duration of 14 years, 1891 of whom had kidney disease and 1218 with retinopathy. The case subjects were matched for diabetes mellitus duration, age, sex, and low-density lipoprotein cholesterol to 3683 control subjects with type 2 diabetes mellitus who did not have kidney disease or retinopathy. The study was conducted in 24 sites in 13 countries. The primary analysis included kidney disease and retinopathy cases. Matched analysis was performed by use of site-specific conditional logistic regression in multivariable models that adjusted for hemoglobin A1c, hypertension, and statin treatment. Mean low-density lipoprotein cholesterol concentration was 2.3 mmol/L. The microvascular disease odds ratio increased by a factor of 1.16 (95% confidence interval, 1.11-1.22) for every 0.5 mmol/L (≈1 quintile) increase in triglycerides or decreased by a factor of 0.92 (0.88-0.96) for every 0.2 mmol/L (≈1 quintile) increase in high-density lipoprotein cholesterol. For kidney disease, the odds ratio increased by 1.23 (1.16-1.31) with triglycerides and decreased by 0.86 (0.82-0.91) with high-density lipoprotein cholesterol. Retinopathy was associated with triglycerides and high-density lipoprotein cholesterol in matched analysis but not significantly after additional adjustment. Diabetic kidney disease is associated worldwide with higher levels of plasma triglycerides and lower levels of high-density lipoprotein cholesterol among patients with good control of low-density lipoprotein cholesterol. Retinopathy was less robustly associated with these lipids. These results strengthen the rationale for studying dyslipidemia treatment to prevent diabetic microvascular disease.

  19. A prospective two-center study on the associations between microalbuminuria, coronary atherosclerosis and long-term clinical outcome in asymptomatic patients with type 2 diabetes mellitus: evaluation by coronary CT angiography.

    PubMed

    Kim, Jin-Jin; Hwang, Byung-Hee; Choi, Ik Jun; Choo, Eun-Ho; Lim, Sungmin; Koh, Yoon-Seok; Lee, Jong Min; Kim, Pum-Joon; Seung, Ki-Bae; Lee, Seung-Hwan; Cho, Jae-Hyung; Jung, Jung Im; Chang, Kiyuk

    2015-01-01

    This study assessed the associations between microalbuminuria in asymptomatic patients with type 2 diabetes and the presence, extent, and severity of coronary atherosclerosis, as measured by coronary computed tomography angiography (CCTA), and the long-term clinical outcomes. In total, the study enrolled 284 consecutive eligible asymptomatic patients with type 2 diabetes and without known coronary artery disease (CAD), who then underwent CCTA and 24 h urine albumin measurements. Microalbuminuria was defined as 30-300 mg/day urinary albumin excretion. Obstructive CAD, as measured by CCTA, was defined as maximum intra-luminal stenosis ≥50 %. Patients with and without microalbuminuria were compared in terms of obstructive CAD prevalence, and the extent and severity of coronary atherosclerosis. They were evaluated using the following data: coronary artery calcium score (CACS), atheroma burden obstructive score (ABOS), segment involvement score (SIS) and segment stenosis score (SSS). All-cause mortality within a follow-up period of 5 years was also compared. Compared to patients without microalbuminuria, patients with microalbuminuria were more likely to have obstructive CAD (p = 0.004). Microalbuminuria was associated with higher ABOS (p = 0.010), SIS (p = 0.029), and SSS (p = 0.011), except for CACS (p = 0.058). Multivariable analyses adjusted for conventional cardiovascular risk factors revealed that microalbuminuria was an independent predictor of obstructive CAD [odds ratio 2.255, confidence intervals (CI) 1.121-4.538, p = 0.023] and all-cause mortality (hazard ratio 3.469, CI 1.319-9.121, p = 0.012). In asymptomatic patients with type 2 diabetes, microalbuminuria was associated with increased risk of CAD and poorer clinical outcomes.

  20. Valsalva retinopathy developing during Japanese cheerleading training ("ouendan").

    PubMed

    Hanazono, Gen; Shinoda, Kei; Obazawa, Minoru; Imamura, Yutaka; Matsumoto, Soiti C; Satofuka, Shingo; Mizota, Atsushi; Ando, Yasutaka

    2013-01-01

    Valsalva hemorrhagic retinopathy is characterized by retinal hemorrhages that develop after a Valsalva maneuver that consists of a forcible exhalation against a closed glottis, thereby creating a sudden increase in the intrathoracic or intraabdominal pressure. We present a patient who developed retinal and vitreous hemorrhages with multiple retinal nonperfused areas after extreme physical training with shouting on a mountainous area. This exercise was part of his training as a member of a Japanese traditional cheerleading team. Case presentation. A 19-year-old man developed an acute decrease in the vision to 0.3 in his left eye after running on hilly roads at approximately 800 m while shouting fight songs for several hours. Ophthalmoscopy showed a fresh vitreous hemorrhage that covered the entire macula and was connected to the optic disk in the left eye. The vitreous hemorrhage spontaneously resolved and an intraretinal hemorrhage and nonperfused area emerged. His visual acuity returned to 1.2. Prolonged, strenuous physical exertion with shouting during training exercises can lead to Valsalva hemorrhagic retinopathy. Several other factors, such as hot weather, altitude, and dehydration, may have played an additive role in increasing the venous pressure and hypoxia in the retinal vessels, which then caused the retinopathy.

  1. [Deficient prevention and late treatment of diabetic retinopathy in Mexico].

    PubMed

    Cervantes-Castañeda, René A; Menchaca-Díaz, Rufino; Alfaro-Trujillo, Beatriz; Guerrero-Gutiérrez, Manuel; Chayet-Berdowsky, Arturo S

    2014-01-01

    Retinopathy is a frequent complication of diabetes, causing visual impairment in 10% and blindness in 2% of diabetic patients. The aim of this study is to describe the clinical profile of diabetic patients in an ophthalmologic unit in Tijuana, México. Retrospective study of a random sample of 500 clinical charts of patients with diabetes who attended the Retina Service of "Fundación CODET para la Prevención de la Ceguera IBP" Ophthalmologic Center between 2006 and 2010. The main complaint of 58% of patients was decreased visual acuity in first evaluation. Only 6.2% of patients were referred by a health professional. Forty-six percent of the patients had a history of diabetes of at least 15 years. Thirty percent had clinically significant visual impairment at first visit, which was associated with a long history of diabetes and previous eye surgery. Twenty-five percent of these patients who were treated at our clinic experienced visual deterioration due to advanced retinopathy. Patients with diabetic retinopathy are referred to ophthalmological service tardily, when visual loss is usually severe and irreversible.

  2. Revisiting the mouse model of oxygen-induced retinopathy

    PubMed Central

    Kim, Clifford B; D'Amore, Patricia A; Connor, Kip M

    2016-01-01

    Abnormal blood vessel growth in the retina is a hallmark of many retinal diseases, such as retinopathy of prematurity (ROP), proliferative diabetic retinopathy, and the wet form of age-related macular degeneration. In particular, ROP has been an important health concern for physicians since the advent of routine supplemental oxygen therapy for premature neonates more than 70 years ago. Since then, researchers have explored several animal models to better understand ROP and retinal vascular development. Of these models, the mouse model of oxygen-induced retinopathy (OIR) has become the most widely used, and has played a pivotal role in our understanding of retinal angiogenesis and ocular immunology, as well as in the development of groundbreaking therapeutics such as anti-vascular endothelial growth factor injections for wet age-related macular degeneration. Numerous refinements to the model have been made since its inception in the 1950s, and technological advancements have expanded the use of the model across multiple scientific fields. In this review, we explore the historical developments that have led to the mouse OIR model utilized today, essential concepts of OIR, limitations of the model, and a representative selection of key findings from OIR, with particular emphasis on current research progress. PMID:27499653

  3. Subretinal organization in stage 5 retinopathy of prematurity.

    PubMed

    Steidl, Scott M; Hirose, Tatsuo

    2003-04-01

    The subretinal organization (SRO) seen in patients who undergo vitrectomy for stage 5 retinopathy of prematurity has not previously been characterized. We report our observations of SRO and correlate its development with previous laser and cryotreatment for neovascular disease. We surveyed data from 426 eyes in a retrospective chart review of 263 patients that underwent open-sky vitrectomy for stage 5 retinopathy of prematurity. Of 426 eyes evaluated, 130 eyes received laser, cryo, or a combination of both treatments. In 44 eyes (10.3%), SRO was observed and considered the cause of incomplete retinal attachment. Three forms of SRO were identified: subretinal bands (63.6%), subretinal plaques (15.9%), and diffuse SRO (18.2%). One patient had both a band and a plaque. SRO developed in 24 eyes after cryotreatment, 3 after laser, and 2 after combination cryo and laser treatment. Fewer untreated eyes than cryotreatment eyes developed SRO (15 of 296 eyes, 5.1%; ( P=0.0001). Eyes without laser or cryotreatment had a 5.1% frequency of developing SRO. Subretinal organization, a previously uncharacterized entity in retinopathy of prematurity, was most frequently identified in the form of subretinal band formation. SRO was identified in 10.3% of all stage 5 eyes evaluated, and was associated with incomplete retinal reattachment in all cases.

  4. Induction of Ischemic Tolerance Protects the Retina From Diabetic Retinopathy

    PubMed Central

    Fernandez, Diego C.; Sande, Pablo H.; Chianelli, Mónica S.; Aldana Marcos, Hernán J.; Rosenstein, Ruth E.

    2011-01-01

    Diabetic retinopathy is a leading cause of acquired blindness. Available treatments are not very effective. We investigated the effect of a weekly application of retinal ischemia pulses (ischemic conditioning) on retinal damage induced by experimental diabetes. Diabetes was induced by an intraperitoneal injection of streptozotocin. Retinal ischemia was induced by increasing intraocular pressure to 120 mmHg for 5 minutes; this maneuver started 3 days after streptozotocin injection and was weekly repeated in one eye, whereas the contralateral eye was submitted to a sham procedure. Diabetic retinopathy was evaluated in terms of i) retinal function (electroretinogram and oscillatory potentials), ii) integrity of blood-retinal barrier (by albumin–Evans blue complex leakage and astrocyte glial fibrillary acidic protein IHC), iii) optical and electron microscopy histopathologic studies, and iv) vascular endothelial growth factor levels (using Western blot analysis and IHC). Brief ischemia pulses significantly preserved electroretinogram a- and b-wave and oscillatory potentials, avoided albumin–Evans blue leakage, prevented the decrease in astrocyte glial fibrillary acidic protein levels, reduced the appearance of retinal edemas, and prevented the increase in vascular endothelial growth factor levels induced by experimental diabetes. When the application of ischemia pulses started 6 weeks after diabetes onset, retinal function was significantly preserved. These results indicate that induction of ischemic tolerance could constitute a fertile avenue for the development of new therapeutic strategies for diabetic retinopathy treatment. PMID:21514439

  5. Autoimmune destruction of pericytes as the cause of diabetic retinopathy.

    PubMed

    Adams, Duncan D

    2008-06-01

    In diabetic retinopathy, collapse of the retinal vasculature is associated with loss of the pericytes. These are contractile cells that together with endothelial cells form the terminal arterioles of the retina. The cause of the loss of pericytes is not known. Recently, it has been discovered that type 1 diabetes is caused by forbidden clones of cytotoxic T lymphocytes, which destroy the insulin-making cells with exquisite specificity. In the light of this, I postulate that an antigenically-related forbidden clone of cytotoxic T lymphocytes selectively destroys the pericytes and that this is the cause of the vascular collapse of diabetic retinopathy. If this is so, the therapeutic implications are immense, involving a switch from ineffectual tight glycemic control to immunotherapy. This is already used as immunosuppression to prevent organ transplant rejection, and as the immune ablation and autologous bone marrow cell reconstitution that has saved the lives of patients with lethally-severe scleroderma. Once the pericyte surface auto-antigen for the T lymphocytes has been isolated, selective destruction of the pathogenic T lymphocytes would be possible by manufacture and use of cytotoxic auto-antigen complexes, which arrests progression of the retinopathy.

  6. Laser therapy for retinopathy in sickle cell disease.

    PubMed

    Myint, Kay Thi; Sahoo, Soumendra; Thein, Aung Win; Moe, Soe; Ni, Han

    2015-10-09

    Sickle cell disease includes a group of inherited haemoglobinopathies affecting multiple organs including the eyes. Some people with the disease develop ocular manifestations due to vaso-occlusion. Vision-threatening complications of sickle cell disease are mainly due to proliferative sickle retinopathy which is characterized by proliferation of new blood vessels. Laser photocoagulation is widely applicable in proliferative retinopathies such as proliferative sickle retinopathy and proliferative diabetic retinopathy. It is important to evaluate the efficacy and safety of laser photocoagulation in the treatment of proliferative sickle retinopathy to prevent sight-threatening complications. To evaluate the effectiveness of various techniques of laser photocoagulation therapy in sickle cell disease-related retinopathy. We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group's Haemoglobinopathies Trials Register, compiled from electronic database searches and handsearching of journals and conference abstract books. Date of last search: 21 September 2015.We also searched the following resources (24 March 2015): Latin American and Carribean Health Science Literature Database (LILACS); WHO International Clinical Trials Registry Platforms (ICTRP); and ClinicalTrials.gov. Randomised controlled trials comparing laser photocoagulation to no treatment in children and adults. Two authors independently assessed trial eligibility, the risk of bias of the included trials and extracted and analysed data. We contacted the trial authors for additional information. Two trials (341 eyes of 238 children and adults) were included comparing efficacy and safety of laser photocoagulation to no therapy in people with proliferative sickle retinopathy. There were 121 males and 117 females with an age range from 13 to 67 years. The laser photocoagulation technique used was different in the two trials; one single-centre trial employed sectoral scatter laser photocoagulation using an

  7. P2X7 receptor antagonism: Implications in diabetic retinopathy.

    PubMed

    Platania, Chiara Bianca Maria; Giurdanella, Giovanni; Di Paola, Luisa; Leggio, Gian Marco; Drago, Filippo; Salomone, Salvatore; Bucolo, Claudio

    2017-08-15

    Diabetic retinopathy (DR) is the most frequent complication of diabetes and one of leading causes of blindness worldwide. Early phases of DR are characterized by retinal pericyte loss mainly related to concurrent inflammatory process. Recently, an important link between P2X7 receptor (P2X7R) and inflammation has been demonstrated indicating this receptor as potential pharmacological target in DR. Here we first carried out an in silico molecular modeling study in order to characterize the allosteric pocket in P2X7R, and identify a suitable P2X7R antagonist through molecular docking. JNJ47965567 was identified as the hit compound in docking calculations, as well as for its absorption, distribution, metabolism and excretion (ADME) profile. As an in vitro model of early diabetic retinopathy, human retinal pericytes were exposed to high glucose (25mM, 48h) that caused a significant (p<0.05) release of IL-1β and LDH. The block of P2X7R by JNJ47965567 significantly (p<0.05) reverted the damage elicited by high glucose, detected as IL-1β and LDH release. Overall, our findings suggest that the P2X7R represents an attractive pharmacological target to manage the early phase of diabetic retinopathy, and the compound JNJ47965567 is a good template to discover other P2X7R selective antagonists. Copyright © 2017 Elsevier Inc. All rights reserved.

  8. EP300 Protects from Light-Induced Retinopathy in Zebrafish

    PubMed Central

    Kawase, Reiko; Nishimura, Yuhei; Ashikawa, Yoshifumi; Sasagawa, Shota; Murakami, Soichiro; Yuge, Mizuki; Okabe, Shiko; Kawaguchi, Koki; Yamamoto, Hiroshi; Moriyuki, Kazumi; Yamane, Shinsaku; Tsuruma, Kazuhiro; Shimazawa, Masamitsu; Hara, Hideaki; Tanaka, Toshio

    2016-01-01

    Exposure of rhodopsin to bright white light can induce photoreceptor cell damage and degeneration. However, a comprehensive understanding of the mechanisms underlying light-induced retinopathy remains elusive. In this study, we performed comparative transcriptome analysis of three rodent models of light-induced retinopathy, and we identified 37 genes that are dysregulated in all three models. Gene ontology analysis revealed that this gene set is significantly associated with a cytokine signaling axis composed of signal transducer and activator of transcription 1 and 3 (STAT1/3), interleukin 6 signal transducer (IL6ST), and oncostatin M receptor (OSMR). Furthermore, the analysis suggested that the histone acetyltransferase EP300 may be a key upstream regulator of the STAT1/3–IL6ST/OSMR axis. To examine the role of EP300 directly, we developed a larval zebrafish model of light-induced retinopathy. Using this model, we demonstrated that pharmacological inhibition of EP300 significantly increased retinal cell apoptosis, decreased photoreceptor cell outer segments, and increased proliferation of putative Müller cells upon exposure to intense light. These results suggest that EP300 may protect photoreceptor cells from light-induced damage and that activation of EP300 may be a novel therapeutic approach for the treatment of retinal degenerative diseases. PMID:27242532

  9. Multispectral fundus imaging for early detection of diabetic retinopathy

    NASA Astrophysics Data System (ADS)

    Beach, James M.; Tiedeman, James S.; Hopkins, Mark F.; Sabharwal, Yashvinder S.

    1999-04-01

    Functional imaging of the retina and associated structures may provide information for early assessment of risks of developing retinopathy in diabetic patients. Here we show results of retinal oximetry performed using multi-spectral reflectance imaging techniques to assess hemoglobin (Hb) oxygen saturation (OS) in blood vessels of the inner retina and oxygen utilization at the optic nerve in diabetic patients without retinopathy and early disease during experimental hyperglycemia. Retinal images were obtained through a fundus camera and simultaneously recorded at up to four wavelengths using image-splitting modules coupled to a digital camera. Changes in OS in large retinal vessels, in average OS in disk tissue, and in the reduced state of cytochrome oxidase (CO) at the disk were determined from changes in reflectance associated with the oxidation/reduction states of Hb and CO. Step to high sugar lowered venous oxygen saturation to a degree dependent on disease duration. Moderate increase in sugar produced higher levels of reduced CO in both the disk and surrounding tissue without a detectable change in average tissue OS. Results suggest that regulation of retinal blood supply and oxygen consumption are altered by hyperglycemia and that such functional changes are present before clinical signs of retinopathy.

  10. What Is Pulmonary Hypertension?

    MedlinePlus

    ... tests. Once you have a diagnosis of pulmonary hypertension, exercise testing can help your doctor determine its severity. ... so the doctor can rate your activity level. Exercise testing may be ongoing ... hypertension The World Health Organization has established five groups ...

  11. HIV and Pulmonary Hypertension

    MedlinePlus

    ... 03-13T18:29:11+00:00 PH and HIV Print PH and HIV Brochure (PDF) Order Copies ... to know about pulmonary hypertension in connection with HIV? Although pulmonary hypertension and HIV are two separate ...

  12. Living with Pulmonary Hypertension

    MedlinePlus

    ... Share this page from the NHLBI on Twitter. Living With Pulmonary Hypertension Pulmonary hypertension (PH) has no ... seek care right away. Emotional Issues and Support Living with PH may cause fear, anxiety, depression, and ...

  13. The Diabetic Retinopathy Barometer Study: Global perspectives on access to and experiences of diabetic retinopathy screening and treatment.

    PubMed

    Cavan, D; Makaroff, L; da Rocha Fernandes, J; Sylvanowicz, M; Ackland, P; Conlon, J; Chaney, D; Malhi, A; Barratt, J

    2017-07-01

    To assess the level of awareness, prevention and treatment of Diabetic Eye Disease (DED) comprising Diabetic Retinopathy (DR) and Diabetic Macula Edema (DME) retinopathy among adults with diabetes and health professionals. The Diabetic Retinopathy Barometer Study consisted of a qualitative study, which consisted of semi-structured interviews, and a quantitative study using online surveys for adults with diabetes and for health professionals. A total of 4340 adults with diabetes and 2329 health professionals participated in the surveys. Diabetic eye disease (DED) without macular edema (DME) was reported by 19.5% of adults with diabetes and a further 7.6% reported that they had DME. Although 94% of adults with diabetes saw a health care professional for their diabetes, only 79% had ever had an eye examination for DED, and 23% had not had an eye examination in the last year. Moreover, 65% of the ophthalmologists surveyed reported that most patients presented when visual problems had already occurred. Overall, 62% of people with DED had received treatment. Of these, 74% had laser therapy, 29% surgery and 24% anti-VEGF therapy. Strategic investment is required to enhance patient education and professional training on the importance of regular eye examinations; and in providing accessible DR screening programmes and proactive treatments. Copyright © 2017 Elsevier B.V. All rights reserved.

  14. Risk of Radiation Retinopathy in Patients With Orbital and Ocular Lymphoma

    SciTech Connect

    Kaushik, Megha; Pulido, Jose S.; Schild, Steven E.; Stafford, Scott

    2012-12-01

    Purpose: Radiation retinopathy is a potential long-term complication of radiation therapy to the orbit. The risk of developing this adverse effect is dose dependent; however, the threshold is unclear. The aim of this study was to identify the risk of developing radiation retinopathy at increasing radiation doses. Methods and Materials: A 40-year retrospective review was performed of patients who received external beam radiation therapy for ocular/orbital non-Hodgkin lymphoma (NHL). Results: Sixty-seven patients who had at least one ophthalmic follow-up examination were included in this study. Most patients (52%) were diagnosed with NHL involving the orbit. Patients received external beam radiation therapy at doses between 1886 and 5400 cGy (mean, 3033 {+-} 782 cGy). Radiation retinopathy developed in 12% of patients, and the median time to diagnosis was 27 months (range, 15-241months). The mean prescribed radiation dose in patients with retinopathy was 3309 {+-} 585 cGy, and the estimated retinal dose (derived by reviewing the dosimetry) was 3087 {+-} 1030 cGy. The incidence of retinopathy increased with dose. The average prescribed daily fractionated dose was higher in patients who developed retinopathy than in patients who did not (mean, 202 cGy vs 180 cGy, respectively; P = .04). More patients with radiation retinopathy had comorbid diabetes mellitus type 2 than patients without retinopathy (P = .015). In our study, the mean visual acuity of the eyes that received radiation was worse than that of the eyes that did not (P = .027). Other postradiotherapy ocular findings included keratitis (6%), dry eyes (39%), and cataract (33%). Conclusions: Radiation retinopathy, a known complication of radiotherapy for orbital tumors, relates to vascular comorbidities and dose. Higher total doses and larger daily fractions (>180 cGy) appear to be related to higher rates of retinopathy. Future larger studies are required to identify a statistically significant threshold for the

  15. Epidemiology of diabetic retinopathy and maculopathy in Africa: a systematic review

    PubMed Central

    Burgess, P I; MacCormick, I J C; Harding, S P; Bastawrous, A; Beare, N A V; Garner, P

    2013-01-01

    Abstract Aim To summarize findings from studies reporting the prevalence and incidence of diabetic retinopathy and diabetic maculopathy in African countries in light of the rising prevalence of diabetes mellitus. Methods Using a predefined search strategy, we systematically searched MEDLINE, EMBASE, Science Citation index and Conference Proceedings Citation index, African Index Medicus and the grey literature database ‘OpenSIGLE’ for studies published between January 1990 and February 2011. Included studies reported prevalence or incidence of diabetic retinopathy or diabetic maculopathy of subjects with diabetes resident in African countries. Results Sixty-two studies from 21 countries were included: three population-based surveys; two cohort studies; five case–control studies; 32 diabetes clinic-based, nine eye clinic-based and 11 other hospital-based surveys. Included studies varied considerably in terms of patient selection, method of assessing the eye and retinopathy classification. In population-based studies, the reported prevalence range in patients with diabetes for diabetic retinopathy was 30.2 to 31.6%, proliferative diabetic retinopathy 0.9 to 1.3%, and any maculopathy 1.2 to 4.5%. In diabetes clinic-based surveys, the reported prevalence range for diabetic retinopathy was 7.0 to 62.4%, proliferative diabetic retinopathy 0 to 6.9%, and any maculopathy 1.2 to 31.1%. No obvious association between prevalence and income level of the country was detected. Conclusions Large, community-based cross-sectional and cohort studies are needed to investigate rates and determinants of prevalence of diabetic retinopathy, incidence and progression in Africa. Consensus is needed on the most appropriate methods of identification and classification of retinopathy for research and clinical practice. Estimates of prevalence of diabetic retinopathy, proliferative diabetic retinopathy and maculopathy are comparable with recent European and American studies. PMID:22817387

  16. Proliferative retinopathy predicts nephropathy: a 25-year follow-up study of type 1 diabetic patients.

    PubMed

    Karlberg, Charlotte; Falk, Christine; Green, Anders; Sjølie, Anne Katrin; Grauslund, Jakob

    2012-08-01

    We wanted to examine proliferative retinopathy as a marker of incident nephropathy in a 25-year follow-up study of a population-based cohort of Danish type 1 diabetic patients and to examine cross-sectional associations between nephropathy and retinopathy in long-term surviving patients of the same cohort. All type 1 diabetic patients from Fyn County, Denmark, were identified as of 1 July 1973. One hundred and eighty four patients were examined in 1981-1982 (baseline) and in 2007-2008 (follow-up). The level of retinopathy was graded by ophthalmoscopy at baseline and nine-field digital colour fundus photographs at follow-up. Single spot urine was used to evaluate nephropathy at both examinations. Proliferative retinopathy was present in 29 patients (15.8%) at baseline. At follow-up, these patients were more likely to macroalbuminuria (20.7% vs. 6.5%) than patients without proliferative retinopathy at baseline. In a multivariate logistic regression adjusted for baseline age, sex, duration of diabetes, smoking, HbA(1,) systolic and diastolic blood pressure, odds ratio of nephropathy (micro- and macroalbuminuria combined) was 2.98 (95% confidence interval 1.18-7.51, p = 0.02) for patients with proliferative retinopathy at baseline as compared to those without. At follow-up, there was a close relation between retinopathy and nephropathy. The level of macroalbuminuria was 4.3, 4.6 and 13.0% for patients with no or mild non-proliferative retinopathy, moderate non-proliferative retinopathy and proliferative retinopathy, respectively. In conclusion, proliferative retinopathy is an independent marker of long-term nephropathy in type 1 diabetes. Upcoming studies should examine whether these microvascular complications are also causally linked in type 1 diabetes.

  17. [Ameliorative effects on retinal disorder in diabetic SHRSP (stroke-prone spontaneously hypertensive rat)].

    PubMed

    Nagisa, Yasutaka; Shintani, Asae; Nakagawa, Shizue

    2002-10-01

    The results of the EUCLID highlighted the importance of the renin-angiotensin system in the pathogenesis of diabetic retinopathy. We aimed to evaluate the effectiveness of candesartan cilexetil(TCV-116), a potent angiotensin II receptor antagonist, in ameliorating retinal disorders in stroke-prone spontaneously hypertensive rats(SHRSP) with storeptozotocin(STZ)-induced diabetes. Retinal VEGF mRNA expression was significantly higher and the latencies of oscillatory potentials were significantly elongated in STZ-treated SHRSP compared with a non-treated SHRSP group matched for age. Treatment with TCV-116(3 mg/kg) significantly diminished retinal VEGF mRNA expression and the latencies of oscillatory potentials, but had no effect on plasma glucose concentrations. These results suggest that TCV-116 is effective in preventing the development of diabetic retinopathy already in the early stages.

  18. Hypertensive brain stem encephalopathy.

    PubMed

    Liao, Pen-Yuan; Lee, Chien-Chang; Chen, Cheng-Yu

    2015-01-01

    A 48-year-old man presented with headache and extreme hypertension. Computed tomography showed diffuse brain stem hypodensity. Magnetic resonance imaging revealed diffuse brain stem vasogenic edema. Hypertensive brain stem encephalopathy is an uncommon manifestation of hypertensive encephalopathy, which classically occurs at parietooccipital white matter. Because of its atypical location, the diagnosis can be challenging. Moreover, the coexistence of hypertension and brain stem edema could also direct clinicians toward a diagnosis of ischemic infarction, leading to a completely contradictory treatment goal.

  19. Economics of hypertension control. World Hypertension League.

    PubMed Central

    1995-01-01

    This paper summarizes the key aspects of the problem of estimating the economic burden of hypertension and hypertension-related disease, the use of economic models, and the opportunities for containing the costs. More information is needed on the population-attributable risk of hypertension in various countries, which is indispensable to estimate the part of hypertension in the burden of stroke and heart disease. The population and high-risk approaches to hypertension control also have economic consequences, which may vary in different societies and must be assessed to ensure proper allocation of resources. Cost-containment can be achieved by more selective diagnostic investigations and by opting for cheaper drugs, though the choice of treatment is difficult owing to uncertainties in the quality-of-life estimates. PMID:7554012

  20. DEPRESSION IN HYPERTENSIVE SUBJECTS

    PubMed Central

    Ramachandran, V.; Parikh, G.J.; Srinivasan, V.

    1983-01-01

    SUMMARY 168 patients attending hypertension clinic were randomly selected for the study. They were thoroughly investigated using E.C.G., X-ray chest, Urine analysis, Blood sugar, Blood urea, Serum cholesterol, Serum K, Serum Na, Scrum creatinine and Uric acid level. Detailed psychiatric case history and mental examination was carried out. Beck Rating Scale was used to measure the depression. 25% of hypertensive subjects exhibited depressive features and their mean score in Beck Rating scale is 21.76. The mean score of non-depressives is 4.46. All patients were receiving methyl dopa.25 mg. twice or thrice daily with thiazide diuretic. No significant difference in the incidence of depression with the duration of medication was observed. The hypertension was classified into mild, moderate and severe depending on the diastolic pressure. Depression was more frequent in severe hypertensives but not to the statistically significant level. Further hypertensives were classified into: 1. Hypertension without organ involvement 2. Hypertension with LVH only 3. Hypertension with additional organ involvement 4. Malignant hypertension Depression was significantly more frequent in hypertensives with complications and also hypertensives in whom the B.P. remained uncontrolled. As all the patients were on the same drug, the drug effect is common to all; hence, the higher incidence of depression in hypertensives with complications is due to the limitation and distress caused by the illness. PMID:21847301

  1. Hypertension in developing countries.

    PubMed

    Tibazarwa, Kemi B; Damasceno, Albertino A

    2014-05-01

    The past 2 decades have seen a considerable global increase in cardiovascular disease, with hypertension remaining by far the most common. More than one-third of adults in Africa are hypertensive; as in the urban populations of most developing countries. Being a condition that occurs with relatively few symptoms, hypertension remains underdetected in many countries; especially in developing countries where routine screening at any point of health care is grossly underutilized. Because hypertension is directly related to cardiovascular disease, this has led to hypertension being the leading cause of adverse cardiovascular outcomes, as a result of patients living, often unknowingly, with uncontrolled hypertension for prolonged periods of time. In Africa, hypertension is the leading cause of heart failure; whereas at global levels, hypertension is responsible for more than half of deaths from stroke, just less than half of deaths from coronary artery disease, and for more than one-tenth of all global deaths. In this review, we discuss the escalating occurrence of hypertension in developing countries, before exploring the strengths and weaknesses of different measures to control hypertension, and the challenges of adopting these measures in developing countries. On a broad level, these include steps to curb the ripple effect of urbanization on the health and disease profile of developing societies, and suggestions to improve loopholes in various aspects of health care delivery that affect surveillance and management of hypertension. Furthermore, we consider how the industrial sectors' contributions toward the burden of hypertension can also be the source of the solution.

  2. Hypertension, kidney disease, HIV and antiretroviral therapy among Tanzanian adults: a cross-sectional study.

    PubMed

    Peck, Robert N; Shedafa, Rehema; Kalluvya, Samuel; Downs, Jennifer A; Todd, Jim; Suthanthiran, Manikkam; Fitzgerald, Daniel W; Kataraihya, Johannes B

    2014-07-29

    hypertension (P <0.001 for trend); among hypertensive participants, 50/76 (65.8%) had microalbuminuria and 20/76 (26.3%) had an estimated glomerular filtration rate (eGFR) <60 versus 33/184 (17.9%) and 16/184 (8.7%) participants with normal blood pressure. HIV-infected adults on ART >2 years had two-fold greater odds of hypertension than HIV-negative controls. HIV-infected adults with hypertension were rarely aware of their diagnosis but often have evidence of kidney disease. Intensive hypertension screening and education are needed in HIV-clinics in sub-Saharan Africa. Further studies should determine if chronic, dysregulated inflammation may accelerate hypertension in this population.

  3. Plasma asymmetric dimethylarginine, symmetric dimethylarginine, l-arginine, and nitrite/nitrate concentrations in cats with chronic kidney disease and hypertension.

    PubMed

    Jepson, R E; Syme, H M; Vallance, C; Elliott, J

    2008-01-01

    Chronic kidney disease (CKD) and hypertension have been associated with decreased bioavailability of nitric oxide (NO) and endothelial dysfunction. Increased concentrations of the endothelial nitric oxide synthase (eNOS) inhibitor asymmetric dimethylarginine (ADMA) are implicated. Plasma ADMA concentration is increased in cats with CKD and systemic hypertension corresponding to a decrease in total plasma nitrate/nitrite (NOx) availability. Decrease in systolic blood pressure (SBP) and proteinuria during treatment of hypertension with amlodipine besylate may be associated with increased NOx availability. Sixty-nine client-owned normotensive and hypertensive cats with variable azotemia. Plasma ADMA, symmetric dimethylarginine (SDMA), and l-arginine were measured simultaneously by hydrophilic-interaction liquid chromatography-electrospray tandem mass spectrometry in cats from 6 groups: normotensive nonazotemic (n = 10), normotensive mildly azotemic (n = 10), hypertensive mildly azotemic with hypertensive retinopathy (n = 20), hypertensive mildly azotemic without hypertensive retinopathy (n = 10), normotensive moderately azotemic cats (n = 10), and hypertensive nonazotemic cats (n = 9). Plasma NOx concentrations were measured. A moderate correlation between plasma creatinine and ADMA (n = 69, r= .608, P < .001), SDMA (n = 69, r= .741, P < .001), and NOx concentrations (n = 69, r= .589, P < .001) was observed. There was no association among plasma ADMA, SDMA, and NOx concentrations and SBP. Plasma ADMA and SDMA concentrations are increased in cats with CKD and correlate with plasma creatinine concentration. This may imply the presence of endothelial dysfunction in cats with CKD. Plasma ADMA concentrations were not associated with systemic hypertension. Treatment of systemic hypertension with amlodipine besylate did not affect plasma ADMA or NOx concentrations.

  4. BR 08-3 MANAGEMENT OF DYSLIPIDEMIA IN HYPERTENSION.

    PubMed

    Muthusamy, V V

    2016-09-01

    relaxation and increased permeability to lipoproteins. Hypertension is also associated with up regulation of lipid oxidation enzymes. Hypertension is clearly associated with vascular endothelium (prothrombotic and pro inflammatory). Oxidative stress and vascular inflammation are increased in the pathogenesis of atherosclerosis. Reduction of both results in the reversal of vascular inflammation.LDL is a major cause of endothelial dysfunction. Microalbuminuria is identified in hypertensive patients and it is also associated with lipid abnormalities including high levels of LDL and TGL, low levels of HDL and elevated levels of LP(a). Today CVD prevention is focussed on treating hypertension with the lowering LDL (<100 mg%),increasing HDL (>40 mg in men) and lowering TGL(<150 mg%). In ALLHAT trial, 10,000 patients were given pravastatin 40 mg daily. At the end of 5 years, only 16.7% reduction in LDL was noted. In ASCOT-LLA trial, intensive therapy lipid lowering was recommended along with Antihypertensive therapy. ACEIs, ARBs, Aldosterone antagonists and Nebivolol improve endothelial function and reduce BP. Statin treatment happens to be as a first line drug therapy in the management of dyslipidemia. Fibrates are generally reserved for Hypertriglyceridemia. Bile sequestrants, Nicotinic acid and drug like Ezetimibe locally acting at the intestine level are also used for dyslipidemia. Single pill combination like Atorvastatin with RASS blocker/Amlodipine may be considered the coexisting hypertension and dyslipidemia.

  5. Spontaneous Closure of a Full-Thickness Macular Hole Associated with Proliferative Diabetic Retinopathy and Persistent Vitreomacular Traction

    PubMed Central

    Reinherz, Benjamin J.; Rubin, Jeffrey S.

    2016-01-01

    Diabetic retinopathy worsens the prognosis of macular holes compared to those of idiopathic etiology. While spontaneous closure of idiopathic macular holes is a well-documented phenomenon, spontaneous closure of macular holes associated with proliferative diabetic retinopathy is rare. We report a case of spontaneous closure of a macular