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H. Yokota, T. Nagaoka, A. Takahashi, E. Sato, Y. Kato, K. Fukui, A. Yoshida; Higher Levels of Prorenin in Patients With Type 2 Diabetes Predict Occurrence of Diabetic Retinopathy. Invest. Ophthalmol. Vis. Sci. 2009;50(13):1339.
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We previously showed that serum levels of prorenin increase with more severe diabetic retinopathy and concluded that the receptor-associated prorenin system plays a crucial role in the pathogenesis of diabetic retinopathy. To ascertain if the measurement of serum levels of prorenin is valuable for predicting the development of diabetic retinopathy, we evaluated the relation between prorenin levels and consecutive fundus changes in patients with type 2 diabetes.
Patients with type 2 diabetes (85 men, 111 women) with no diabetic retinopathy were enrolled in this study. All patients provided serum samples and the serum prorenin levels were measured using the antibody-activating direct kinetic assay. The occurrence of diabetic retinopathy was the primary end point. Kaplan-Meyer analysis was used to analyze the results.
Patients were divided into two groups based on the median serum prorenin level (men, 224.3 pg/ml; women, 114.2 pg/ml). The serum prorenin levels were 136±53 pg/ml (mean ± SD) (low in men), 501±361 pg/ml (high in men), 78±28 pg/ml (low in women), and 217±134 pg/ml (high in women). Kaplan-Meyer analysis showed a significant difference in the occurrence of diabetic retinopathy between the high and low groups in men (log-rank test, p<0.01), with men in the high group tending to have worse retinopathy. Although there was no significant difference in the progression of diabetic retinopathy in women (p=0.58), patients in the high group tended to develop diabetic retinopathy earlier than those in the low group.
These results indicated that the measurement of serum prorenin levels in diabetes could be a new prognostic indicator of the development of diabetic retinopathy. Moreover, this study indicates that it is important to consider gender in the pathogenesis of diabetic retinopathy.
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