Article

Diabetologia

, Volume 53, Issue 8, pp 1638-1646

The relationship of retinal vessel diameter to changes in diabetic nephropathy structural variables in patients with type 1 diabetes

  • R. KleinAffiliated withDepartment of Ophthalmology and Visual Sciences, University of Wisconsin-Madison Email author 
  • , M. D. KnudtsonAffiliated withDepartment of Ophthalmology and Visual Sciences, University of Wisconsin-Madison
  • , B. E. K. KleinAffiliated withDepartment of Ophthalmology and Visual Sciences, University of Wisconsin-Madison
  • , B. ZinmanAffiliated withDepartment of Medicine, Leadership Sinai Center for Diabetes, Mount Sinai Hospital, University of Toronto
  • , R. GardinerAffiliated withDepartment of Medicine, McGill University
  • , S. SuissaAffiliated withDepartments of Epidemiology and Biostatistics and Medicine, McGill University
  • , A. R. SinaikoAffiliated withDepartment of Pediatrics, University of Minnesota
  • , S. M. DonnellyAffiliated withDepartment of Medicine, Saint Michael’s Hospital, University of Toronto
  • , P. GoodyerAffiliated withDepartments of Pediatrics and Epidemiology and Biostatistics, McGill University
    • , T. StrandAffiliated withDepartment of Pediatrics, University of Minnesota
    • , M. MauerAffiliated withDepartment of Pediatrics, University of Minnesota

Abstract

Aims/hypothesis

We examined whether retinal vessel diameter in persons with type 1 diabetes mellitus is associated with changes in subclinical anatomical and functional indicators of diabetic nephropathy.

Methods

Persons with type 1 diabetes mellitus had gradable fundus photographs and renal biopsy data at baseline and 5-year follow-up (n = 234). Retinal arteriolar and venular diameters were measured at baseline and follow-up. Central retinal arteriole equivalent (CRAE) and central retinal venule equivalent (CRVE) were computed. Baseline and 5-year follow-up renal structural variables were assessed by masked electron microscopic morphometric analyses from percutaneous renal biopsy specimens. Variables assessed included: mesangial fractional volume, glomerular basement membrane width, mesangial matrix fractional volume and glomerular basement membrane width composite glomerulopathy index.

Results

While controlling for other covariates, baseline CRAE was positively associated with change in the glomerulopathy index over the 5-year period. Change in CRAE was inversely related to a change in mesangial matrix fractional volume and abnormal mesangial matrix fractional volume, while change in CRVE was directly related to change in the volume fraction of cortex that was interstitium [Vv (Int/cortex)] over the 5-year period. Baseline CRAE or CRVE or changes in these diameters were not related to changes in other anatomical or functional renal endpoints.

Conclusions/interpretation

Independently of other factors, baseline CRAE correlated with changes in glomerulopathy index, a composite measure of extracellular matrix accumulation in the mesangium and glomerular basement membrane. A narrowing of the CRAE was related to mesangial matrix accumulation. Changes in CRVE were related to changes in Vv (Int/cortex), a measure of interstitial expansion in persons with type 1 diabetes mellitus.

Keywords

Epidemiology Microvascular disease Nephropathy Retinal blood vessel diameters Risk indicators Type 1 diabetes mellitus