Renal-retinal syndrome

0
0
Поделиться
Хайдарова F., Янгиева N., Акшей K., Абасханова N., & Султанов B. (2003). Renal-retinal syndrome. in Library, 2(2), 19–22. извлечено от https://inlibrary.uz/index.php/archive/article/view/14386
Ф Хайдарова, Ташкентский медицинский институт последипломного образования

доктор философии

Н Янгиева, Ташкентская медицинская академия

доктор философии

Кера Акшей, Ташкентский медицинский институт последипломного образования

доктор философии, доктор медицинских наук

Н Абасханова, Ташкентская медицинская академия

доктор философии, доктор медицинских наук

0
Цитаты
Crossref
Сrossref
Scopus
Scopus

Аннотация

The late complications of the DM are one of the  basic  reasons  of  premature  physical  inability and  lethality  of  the  DM  patients,  which  puts essential harm to the health of the population and the economy as a whole (2). Proceeding from it in the foreground of the problem of prophylactics of the given DM complications is put forward.

Похожие статьи


background image

Tropical Ophthalmology

/ 19

R

ENAL

-

RETINAL

S

YNDROME

D

R

.

F.A.

K

HAIDAROVA

,

P

H

.D.

D

R

.

A

KSHEY

K

HERA

,

D

R

.

N.R.

Y

ANGIEVA

,

P

H

.D.

D

R

.

N.K

H

.

A

BASKHANOVA

,

B.A.

S

ULTANOV

Tashkent Medical Institute of Post

Graduate Study, First Tashkent State Medical Institute

Tashkent, Uzbekistan

Key words:

diabetes mellitus (DM),

complications, diabetic retinopathy (DR), risk
factors, diabetic nephropathy (DN), clinical DN
(CN), and chronic renal insufficiency (CRI).

The late complications of the DM are one of

the basic reasons of premature physical inability
and lethality of the DM patients, which puts
essential harm to the health of the population and
the economy as a whole (2). Proceeding from it in
the foreground of the problem of prophylactics of
the given DM complications is put forward.

For the development of effectual measures of

prophylactics it is necessary to study features of a
course, prevalence and to reveal the factors
promoting the development of the late
complications of the DM.

Recently the association between DN and DR

has being actively discussed in literature.

The purpose of the present work was a study

of the frequent- of the late complications of DM on
the population of the DN patients in Tashkent city
conditions and the study of the risk factors
promoting their development.

The given article is devoted to the analysis of

the received information on the association
between DN and DR and the factors of its
development.

In the City Endocrinology Dispensary a

single time research in the epidemiology of the late
DM complications is performed. Cohort method is

used for selection of observation units. Cohort was
formed in accordance with all basic attributes of
general set: typicalness by sex, age (18-75 years)
and type of DM.
. For processing the selected totality of the
representative group of DM patients the formula of
unrepeated random selection offered by R.N.
Biryukova was used.

All surveyed were interrogated on the

specially developed card. The card is developed on
the basis of an information medical sheet offered
by the European regional bureau of the WHO and
is adapted according to purposes and research
problems.

The card includes the items of information on

the patients, duration of disease and treatment
(diet observance, receptions of tablet sugar reduce
preparations and insulin, duration of reception of
preparations, dose of shortactive and prolonged
forms of insulin, frequency of injections per - day).

Analyzed anthropometrical and biochemical

parameters, the presence and expressivities of
changes on the fundus of the eye, functions of
kidneys, vascular system, nervous and genital
systems as the most often displays of late
complications revealed presence in anamnesis
hereditary history on DM and hypertensive
disease. In women we analyzed the quantity of
pregnancies in anamnesis and


background image

Tropical Ophthalmology

/ 20

their results. We determine the common presence
in anamnesis of both hypoglycemic and
hyperglycemic. We estimated the risk factors and
their characters. Found out the level of knowledge
in the patient about DN and the degree of
realization by himself of selfchecking. Diagnostics
and screening of diabetic nephropathy performed
by qualitatively defining proteinuria with the help
of the Phan test of thf' Lachema" firm. The test was
considered positive, if the albumin concentration in
urine was more than 300 mg/ day.

Diagnostics and screening of the peripheral

neuropathy performed on the basis of the
definition of vibrating sensitivity with the help of
the graduated tuning fork. The research was
performed on a horizontal patients condition.

Diabetic retinopathy diagnostics performed

by way of selection data from medical cards and if
necessary examining the fundus of the eye with the
help of the indirect ophthalmoscopy after the
dilation of pupil. Revealed changes classified by
ophthalmoscopic criteria were offered by the E.
Koner and M. Porta.

Ischemic heart disease (IHD), vessels

macroangiopathy of the lower extremities was
established on the basis of combination of the
positive answers on the standard Rouse's
questionnaire with the presence of stenocardia,
myocardial infraction, alternating lameness
syndrome, and, also if necessary on the basis of
ECG and reovasography examinations.

The total number of patients: 1201 persons,

out of the men - 40.5% (486), women - 59.5% (715).
Patients suffering from insulin-dependent DM
(IDDM) - 201, from non-insulin dependent DM
(NIDDM) - 1000.

By the presence of IDDM the greatest number

of patients are registered till 40 years (70.1%), and
with NIDDM - more senior than 50 years Id
(75,6%).

The distribution of those surveyed on the

duration of DM has shown, that greatest quantity
of the patients was with the disease duration of 6-
10 years.

On a compensation degree patients were

distributed as follows

-

with IDDM:

1.

with the compensated course -2.5%,

2.

with the subcompensated course - 39.3%,

3.

with decompensated course - 58.2%.

With NIDD1C accordingly:

1.

13.3%,

2.

47.8%,

3.

38.9%.

In the examinees with diabetes mellitus the

DN - DP combination was found in 44.7% of
patients with type I diabetes mellitus and in 31,9%
of those with type II diabetes mellitus. The direct
correlation was observed between DN phase and
DR clinical implication (Table 1). In clinical DN and
chronic renal insufficiency (CRI) diabetic
retinopathy was registered in all examinees,
absence of changes in the fundus of eye being
typical of the examinees without renal changes.

Comparison of the fundus vessels in

groups of patients with renal changes, that is, those
having diabetic retinopathy with nephropathy
with those without diabetic nephroangiopathy
showed that in patients with type II diabetes
mellitus and proteinuria preproliferative (DRII)
and proliferative diabetic (DRIH) retinopathies
were diagnosed 2.5 more frequently than in those
without diabetic nephropathy, in 60.4% and 25.0%
of cases, respectively. In type I diabetes mellitus the
ratio was

III

and 29.4% (P<0.001).

It should be noted that there were 2 times

more persons with the disease duration longer than
10 years among the diabetics (regardless of
diabetes type) with the combination of DR and DN,
as compared with those without diabetic
nephroangiopathy

(Table

2,3),

sub-

and

decompensated diabetes mellitus being observed 2
times more frequently (Table 4).

Confidently high systolic arterial pressure


background image

Table 1

Tropical Ophthalmology

/ 21

Diabetic nephroangiopathy incidence dependence on diabetic retinopathy severity

(%)

Diabetic
retinopathy
Severity

Type I diabetes mellitus

Type II diabetes mellitus

No. of patients CN

CRI

No. of patients CN

CRI

DR I

79

36.7+2.7

-

470

29.3+2.6

-

DR

П

65

76.6+2.7

4.6+1.2

284

61.2+2.8

3.5+1.2

DR III

14

4.28+2.6

57.1+2.3

38

28.9+2.5

Total

158

50.0+2.8

6.9+1.6

792

40.7+2.7

Table 2

Renal-retinal syndrome incidence dependence on type I diabetes mellitus duration and DR severity (%)

Disease
duration

No

DR without nephropathy

Total

DR with nephropathy

Total

DR I

DR

П

DRIII

DRI

DRII

DRIII

Less than a
year

22

9.0+0.8

-

-

9.0+0.8

-

-

-

-

1-5

years

47

29.7+1.3

6.3+1.7

-

36.1+1.5

12.7+1.0

4.2+1.0

-

17.0+1.2

6-10

years

51

43.1+1.5

13.7+1.0

-

56.8+1.2

25.4+1.3

15.6+1.6

-

41.1+1.5

11-15

years

39

20.5+1.7

17.9+1.7

-

38.4+1.9

17.9+1.7

38.4+1.7

5.1+0.7

61.5+1.2

16 and
more

years

42

9.5+0.7

2.3+1.0

-

11.9+1.2

7.1+1.2

52.3+1.2

28.5+1.4

88.0+1.4

Total

201

2.4+1.0

6.9+0.8

-

33.8+1.0

14.4+1.2

23.3

6.9+0.7

44.0+1.4

Table 3

Renal-retinal syndrome incidence dependence on type II diabetes mellitus duration and DR severity
(%)

Disease
duration

No.

DR without nephro

jathy

Total

DR with nephropathy

Total

DR I

DR

П

DRIII

DRI

DRII

DRIII

Less than a
year

161

18.6+1.2

0.62+0.62

-

19.0+1.2

5.5+1.7

-

-

5.5+1.7

1-5 years

221

31.2+1.4

65.8+1.5

0.45+0.4

37.5+1.6

23.0+1.3

1.8+0.8

-

24.8+1.9

6-10 years

235

56.1+1.6

9.3+1.8

0.85+0.5

66.3+1.6

19.1+1.5

12.7+1.1

-

31.9+1.2

11-15 years

201

23.6+1.3

-

0.99+0.7

54.2+1.5

14.4+1.7

28.3+1.7

28.3+1.7

50.7+1.5

16 and
more years

182

29.6+1.3

2.1+1.0

3.2+1.3

35.1+1.5

2.1+1.0

51.0+1.7

11.5+1.3

64.8+1.5

Total

1000

33.2+1.4

10.0+0.9

1.1+0.3

44.3±1.5

13.8+1.0

18.4+1.2

2.7+0.5

34.0+1.5


background image

Table 4

Tropical Ophthalmology

I

T2.

Renal-retinal syndrome incidence in dependence on diabetes mellitus control (%,+m)

Control

Type I diabetes mellitus

Type

П

diabetes mellitus

No.

DR without
nephropathy

DR with
nephropathy

No.

DR without
nephropathy

DR with
nephropathy

Compensated

5

-

20.0±0.4

133

33.0±1.3

8.2±0.8

Subcompensated

79

39.2±1.4

3.9+1.3

478

42.2±1.4

Decompensated

117

33.9±1.3

53.8±1.5

389

50.6±1.6

49.3±1.5

(regardless of diabetes type) was observed in
patients with DR and nephropathy as compared to
those without nephropathy. Mean systolic arterial
pressure in patients with type I diabetes mellitus
and DR without nephropathy was 131.75+23
mmHg, in the group with DR and renal changes it

was 149.88±26.1 mm Hg. Upon type П

diabetes

mellitus the values were 136.09±21 mm Hg and
155,46±25 mm Hg, respectively. Diastolic arterial

pressure upon type I diabetes mellitus in the group
of patients with DR and nephropathy was 92.6+12
mm Hg, in the group of persons with DR without

nephropathy 71,50±14 mm Hg. Upon type Ц,
diabetes mellitus the values were 97.47±14 mm Hg
and 84,84±12 mm Hg, respectively. It should be

noted that upon DR with nephropathy the arterial
hypertension family burden was higher than the
one in the group of patients with DR without
nephropathy (upon type I diabetes mellitus being
56.0% and 19.5%, upon type

П

diabetes mellitus

50.6% and 34.8%, respectively).

The "DM family burden" and "obesity"

factors were found insignificant in patients with
the DR - DN combination (P>0.05).

The findings confirm the opinion that both

insufficient

compensation

of

carbohydrate

metabolism and arterial hypertension play a
significant role in DN pathogenesis, DR reflecting
the general increase of endothelium barriers
permeability for blood plasma proteins.

The analysis of mean blood serum cholesterol

showed that in patients with the DR and DN
combination as compared with those without renal

changes the total cholesterol is higher. Upon type I
diabetes mellitus in patients with the DR - DN

combination mean cholesterol was 5.9±lmmol/l, in

persons with DR without nephroangiopathy it was

3.4±1.7mmol/l, upon type П

diabetes mellitus the

values being 7.7±1.2mmol/l and 5.7±1.0mmol/l,

respectively.

Thus, the findings show that 44.5% of

patients with type I diabetes mellitus and 31.9% of
those with type II diabetes mellitus had the DR -
DN combination to be the evidence for renal-
retinal syndrome in the patients of the kind.

L

ITERATURE

1.

Contribution of hypertension to the development

of diabetic retinopathy: an epidemiological
study. Maltseff A., Longo E., Carlone C. et al.
Giom. It. Di. Diabetol. - 1995 - V. 15. P. 25-28.

2.

David M. Nathan. Long Term complications of

diabetes mellitus The New Engl. J. Med., 1993. -
V. 10. P. 1676-1683.

3.

Development of diabetic retinopathy and its

associated risk factors in type II diabetes
patients in Osaka district. Japan: a long

-

term

prospective.

4.

Glucose control and the renal and retinal

complications of insulin-dependent diabetes.
Chase H.P., Jackson W.E., Hoops S.L., et al.
JAMA

-

1989 - V. 261. - P. 1155-1160.

5.

Lee E.T., Keen H., Bennett P.H. et al. Follow - up

of the multinational study of vascular disease in
diabetes: general description and morbidity
Diabetologia

-

2001. - 44

-

P.3-13.

6.

Picup J.C., Williams G. Textbook of Diabetes.

Blackwell Science. 1997.

Библиографические ссылки

Contribution of hypertension to the development of diabetic retinopathy: an epidemiological study. Maltseff A., Longo E., Carlone C. et al. Giom. It. Di. Diabetol. -1995 - V. 15. P. 25-28.

David M. Nathan. Long Term complications of diabetes mellitus The New Engl. J. Med., 1993. -V. 10. P. 1676-1683.

Development of diabetic retinopathy and its associated risk factors in type II diabetes patients in Osaka district. Japan: a long - term prospective.

Glucose control and the renal and retinal complications of insulin-dependent diabetes. Chase H.P., Jackson W.E., Hoops S.L., et al. JAMA -1989 - V. 261. - P. 1155-1160.

Lee E.T., Keen H., Bennett P.H. et al. Follow - up of the multinational study of vascular disease in diabetes: general description and morbidity Diabetologia - 2001. - 44 - P.3-13.

Picup J.C., Williams G. Textbook of Diabetes. Blackwell Science. 1997.

Hepagreen - восстановление нормальной работы печени Androgard — препарат для настоящих мужчин Androgard — препарат для настоящих мужчин Byutivit - Натуральный продукт для женщин любого возраста Byutivit - Натуральный продукт для женщин любого возраста Byutivit - Натуральный продукт для женщин любого возраста Maksimus - Натуральный продукт, для бодрости и энергии Lactovita - Номер один в естественном улучшении иммунитета Lactovita - Номер один в естественном улучшении иммунитета Avicenna’s Lab inLibrary — это научная электронная библиотека UACD - Антикоррупционный дайджест Узбекистана inConference - научно-практические конференции inScience - Журнал Общество и инновации Gulyamov - Гулямов Саид Саидахрарович MUVI24 - Смотрите фильмы онлайн, большая коллекция, новинки кинопроката Megatorg - Доска объявлений Megatorg.net: сайт бесплатных частных объявлений Skinormil - Космецевтика активного действия Pils - Интернет-аптека >METAMED - Фармацевтическая компания с полным спектром услуг All.Tube - Смотрите онлайн видео бесплатно в хорошем качестве Dexaflu - от симптомов гриппа и простуды UMAR PROEKT - Комплексное проектирование UZDA - Ассоциации стоматологов Узбекистана