Title of project

Diabetic retinopathy and nephropathy – can the eye see the future of the kidney

Abstract

Diabetic retinopathy and diabetic nephropathy are two common complications of both type 1 diabetes and type 2 diabetes. Diabetic retinopathy remains the leading cause of blindness among the working-age population, and diabetic nephropathy is considered the leading cause of kidney failure. It is hypothesized that the development of diabetic retinopathy and diabetic nephropathy follows similar pathophysiological pathways, resulting in, for example, thickening of the basement membrane of endothelial cells in the capillaries of the retina and the glomeruli, as well as the loss of pericytes in the retina or podocytes in the glomeruli.

Only a few individuals with diabetes undergo clinical kidney biopsy to confirm the presence of diabetic nephropathy. Therefore, the presence of diabetic retinopathy has long been used in clinical practice to support a diagnosis of diabetic nephropathy in patients with diabetic kidney disease. However, current guidelines describing the screening or treatment of either complication do not consider how the presence of one condition may affect the risk of development or progression of the other.

To investigate features related to the development and progression of diabetic retinopathy and diabetic nephropathy, we have created a retrospective patient cohort including all patients with a diagnosis of diabetes who subsequently underwent kidney biopsy. The cohort currently includes data from the Danish health registers on 2586 patients and will be supplemented with data from proteomic and epigenetic analyses of kidney tissue from historical kidney biopsies. We will also include more detailed data from eye screenings of the patients in the cohort. Data will be analyzed using descriptive parametric statistics and proportional hazards regression models, such as the Cox regression model, where appropriate.

Our goal is to improve the approach to individuals with diabetes by informing more personalized screening protocols and treatment strategies for patients affected by both of these diabetic microvascular complications.