Proliferative diabetic retinopathy: at risk patients identified by early detection of microalbuminuria

The aim of the study was to clarify if these diabetics, with the greatest risk for development of proliferative retinopathy, could be identified by early measurement of urinary albumin excretion (UAE), using sensitive methods. In addition, the possible role of blood pressure was assessed. All male diabetics originally examined in 1969-1976 were re-examined by measuring UAE and blood pressure together with an ordinary ophthalmoscopic examination. Patients fulfilling the following criteria were incorporated in the study: age at diagnosis of diabetes less than 20 years; initial duration of diabetes 7-20 years; follow-up period greater than 7 years, and no clinical proteinuria. 44 patients were identified, all but one accepted re-examination. 29 patients initially had UAE less than 15 micrograms/min, one of these developed proliferative retinopathy. 14 patients initially had UAE greater than or equal to 15 micrograms/min, 9 of these developed proliferative retinopathy. Blood pressure was elevated both initially and at follow-up in diabetics showing progression to proliferative retinopathy. It is concluded that even a slightly elevated UAE 'micro-albuminuria', is a strong predictor with respect to development of proliferative retinopathy.