The University of Melbourne, Department of Medicine, Northern Health, Cooper Street, Melbourne, Victoria 3076 Australia.
Clin J Am Soc Nephrol. 2011 Aug;6(8):1866-71. doi: 10.2215/CJN.10321110. Epub 2011 Jul 22.
Retinal abnormalities are common in inherited and acquired renal disease. This study determined the prevalence of retinal abnormalities in chronic kidney disease (CKD) stages 3 to 5.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: One hundred fifty patients with CKD stages 3 to 5 and 150 age- and gender-matched hospital patients with CKD stages 1 to 2 underwent bilateral retinal photography. These images were reviewed for incidental abnormalities, microvascular (Wong and Mitchell classification) and diabetic retinopathy (Airlie House criteria), and macular degeneration (Seddon classification).
Three (2%) patients with CKD stages 3 to 5 had retinal features characteristic of inherited renal disease (atrophy in Myopathy, Encephalopathy, Lactic Acidosis, Stroke-like episodes [MELAS] syndrome; and 2 with drusen in dense deposit disease). Fifty-nine (39%) patients had moderate-severe microvascular retinopathy (hemorrhages, exudates, etc.) compared with 19 (13%) with CKD stages 1 to 2. Forty-one (28%) had moderate-severe diabetic retinopathy (microaneurysms, exudates, etc.) compared with 16 (11%) with CKD stages 1 to 2. Ten (7%) had severe macular degeneration (geographic atrophy, hemorrhage, exudates, membranes) compared with one (1%) with CKD stages 1 to 2. Renal failure was an independent risk factor for microvascular retinopathy, diabetic retinopathy, and macular degeneration. Eleven (7.3%) patients with renal failure and one (0.7%) with CKD stages 1 to 2 had previously unrecognized vision-threatening retinal abnormalities that required immediate ophthalmologic attention.
Retinal abnormalities are common in CKD stages 3 to 5, and are more severe and more likely to threaten vision than in hospital patients with CKD stages 1 to 2.
视网膜病变在遗传性和获得性肾脏疾病中较为常见。本研究旨在确定慢性肾脏病（CKD）3 至 5 期患者的视网膜病变发生率。
设计、地点、参与者和测量方法：150 名 CKD 3 至 5 期患者和 150 名年龄和性别匹配的 CKD 1 至 2 期住院患者接受了双眼视网膜摄影。评估这些图像是否存在偶然的异常、微血管病变（Wong 和 Mitchell 分类）和糖尿病视网膜病变（Airlie House 标准）以及黄斑变性（Seddon 分类）。
3 名（2%）CKD 3 至 5 期患者的视网膜表现具有遗传性肾脏疾病特征（MELAS 综合征的萎缩；2 名患有致密沉积物病的 drusen）。59 名（39%）患者存在中重度微血管性视网膜病变（出血、渗出等），而 CKD 1 至 2 期患者为 19 名（13%）。41 名（28%）患者存在中重度糖尿病视网膜病变（微动脉瘤、渗出等），而 CKD 1 至 2 期患者为 16 名（11%）。10 名（7%）患者存在重度黄斑变性（地图样萎缩、出血、渗出、膜），而 CKD 1 至 2 期患者仅 1 名（1%）。肾衰竭是微血管性视网膜病变、糖尿病视网膜病变和黄斑变性的独立危险因素。11 名（7.3%）肾衰竭患者和 1 名（0.7%）CKD 1 至 2 期患者存在以前未被发现的威胁视力的视网膜异常，需要立即进行眼科治疗。
CKD 3 至 5 期患者的视网膜病变较为常见，且比 CKD 1 至 2 期住院患者更为严重，更有可能威胁视力。
