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C. E. Myers, B. E. K. Klein, K. E. Lee, R. Klein; The Relationship of Retinal Vessel Diameters to the Incidence of Proteinuria in Pregnant and Non-Pregnant Diabetic Women. Invest. Ophthalmol. Vis. Sci. 2009;50(13):103.
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To determine whether retinal blood vessel diameters are markers for a heightened risk of proteinuria development in pregnant and non-pregnant younger onset Type 1 diabetic women.
Insulin-taking diabetic women were recruited from 1982 to 1986. Protein in urine using a dipstick, glycosylated hemoglobin A1, and blood pressure were measured and retinal photographs were taken at baseline and at a 1 year follow-up examination in all women. The baseline exam was during the first trimester for pregnant women. The mean central retinal arteriole equivalent (CRAE) and mean central retinal venule equivalent (CRVE) was evaluated from the Diabetic Retinopathy Study Field 1 photographs.
Of the 249 women, 13 (5.2%) developed proteinuria (≥30 mg/L) by the 1 year follow-up visit. Five (5.8%) of the 86 pregnant women and 8 (4.8%) of the 165 non-pregnant women developed proteinuria. The incidence of proteinuria was not significantly different between the two groups (p=0.84). After controlling for baseline glycosylated hemoglobin A1, duration of diabetes, systolic blood pressure, and pregnancy status, larger CRVE at baseline was associated with an increased risk of developing proteinuria (Odds Ratio 1.03 per µm increase in CRVE, 95% CI 1.01-1.05, P=.01). Baseline CRAE was not significantly associated with incidence of proteinuria.
These analyses show that wider retinal venular diameter is associated with incidence of diabetic nephropathy independent of glycemia, systolic blood pressure, and pregnancy status. This information is important for developing a deeper understanding of how retinal vessel measurement and pregnancy affect the risk of incidence of proteinuria in insulin-taking diabetic women.
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