Diabetic eye disease adn nephropathy Flashcards
What are the risk factors for diabetic eye disease?
Poor glycaemic contorl, high BP, high LDL cholesterol, long duration of diabetes, pregnancy
What are the three main effects that microangiopathy has on the retina?
Forms microaneurysms which:
- Form blot haemorrhages when they burst
- Hard exudates and oedema when they leak
- Cotton wool spots from local infarcts
What does sudden loss of vision indicate has happened?
Vitreous haemorrhage
What is the difference between background retinopathy and pre-proliferative retinopathy?
Background is microaneurysms, haemorrhages and hardexudates
Pre proliferative is cotton wool spots from infarcts
Why does hyperglycaemia cause nephropathy?
It increases growth factors and RAAS activity
This causes oxidative stress and damage to podocytes aswell as increased glomerular capillary pressure
How is diabetic nephropathy diagnosed?
Microalbuminuria shown by an albumin:creatine ratio of 3-30mg/mmol
What is the treatment of diabetic nephropathy?
It requires intensive DM control to prevent microalbuminuria progressing to macro (>30mg A:Cr)
BP <130/80 and use ACEi to reduce renal perfusion pressure and protect kidneys
Sodium restriction
What are the three stages of diabetic retinopathy?
There is background retinopathy - haeorrhages and hard exudates
Pre-proliferative retinopathy - cotton wool spots
Proliferative retinopathy - formation of new vessels
What is the first stage of diabetic retinopathy?
R1 this is background retinopathy and is not sight threatening
There are haemorrhages and hard exudates not afffecting the macula
What is the second stage of diabetic retinopathy?
R2 is pre prolifertive retinopathy - this is sight threatening
There are more than 5 cotton wool spots showing retinal ischaemia
There may be beading and venous thickening
What is the third stage of diabetic retinopathy?
R3a means active - This is proliferative retinopathy and formation of new blood vessels
What is diabetic maculopathy?
This will be M1 and will involve spread of haemorrhages and hard exudates to involve the macula
