Chronic exudates or arteriovenous nipping, focal arteriolar narrowing, or

Chronic Kidney Disease has become one
of the big burdens to the world and its major causes are increasing incidence
of diabetes, hypertension, obesity and the sedentary life style. CKD according
to K/DOGI is defined as abnormalities of kidney structure or function, present
for more than 3 months, with implications for health and is classified into
various stages on the basis of cause, GFR, and albuminuria. The worldwide
prevalence of CKD is estimated to be 8-16% 1. Leading cause of CKD is
diabetic kidney diseases approximately 40% and others are non-diabetic renal disease (NDRD) causes
which includes mainly immunoglobulin A (IgA) nephropathy in Asian population
and focal segmental glomerulosclerosis (FSGS) in western countries 2.

CKD being an inflammatory disease has
impact on all the aspects of the body. It has effect on the vessels especially
the microvasculature 3.The Patients with chronic kidney
disease experience co-morbid illnesses, including
cardiovascular disease (CVD) and retinopathy 4. Our findings may provide evidence that
presence of retinopathy reflect early subclinical damage in the renal
microvasculature that is subsequently associated with development of renal
disease. So it becomes
very important to early recognize the condition and take measures to avoid the
progression and complications of the disease.

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Retinopathy is defined as presence of retinal
micro vascular abnormalities (micro aneurysms, hemorrhages, hard and soft
exudates or arteriovenous nipping, focal arteriolar narrowing, or lowest
quartile arteriole-venue ratio). The retinal micro vascular examination is
easiest way to visualize the micro vascular changes in human body and retinal
vasculature may reflect similar changes in renal vasculature. Micro vascular abnormalities
have been suggested to represent early pathological abnormalities in the
kidney.
5 However, such micro
vascular changes occurring in the glomerular vascular bed cannot be visualized
directly and non-invasively 6. Retinal and renal circulations share similar anatomic and
physiologic characteristics, 7, 8, and 9. The retinal microvasculature
provides an opportunity to study the renal microvasculature Many renal diseases
also have characteristic retinal features. This is particularly true of
inherited renal disease because the inner retina and glomerular filtration
barrier share developmental pathways 10 and structural features 11,
including ciliated epithelial cells 12, basement membranes comprising ?3?4?5 collagen IV, and the
extensive capillary beds seen in the choriocapillaris and glomerulus 13.
Retinal abnormalities in inherited renal disease include drusen (Alport
syndrome, dense deposit disease), coloboma (reflux nephropathy), retinitis
pigmentosa (nephronophthisis; Myopathy, Encephalopathy, Lactic Acidosis,
Stroke-like episodes MELAS syndrome), crystal deposits (oxalosis,
cystinosis), and vascular anomalies (Hereditary Angiopathy, Nephropathy, and
muscle Cramps syndrome; Fabry disease) 14, 15. Retinal effects in
acquired renal disease include vasculitis and infarcts in systemic lupus
erythematous, Wegener granulomatosis and microscopic polyangitis 16, 17,
and possibly central serous retinopathy in Goodpasture syndrome, in which
antibodies bind to the internal limiting and Bruch membranes 18.

Non-invasively Ocular
photography may provide a noninvasive method to assess the vascular condition
of the kidneys 19.  There is
increased prevalence of retinopathy in patients with CKD 20.

Various
studies have been done to show the co-relation between retinopathy and CKD. A
study conducted by Sabanayagam
C et al in adults of Malay ethnicity aged 40-80 years
living in Singapore showed that retinopathy was found to be positively
associated with both estimated glomerular filtration rate (eGFR) and
micro/macro albuminuria and that retinal arteriolar narrowing is associated
with chronic kidney disease, independent of diabetes and Hypertension 21.Juan E. Grunewald et al in
chronic renal insufficiency study showed that 11% of non-diabetic and 49
percentage of diabetic CKD patients has retinopathy 22.

Another
study conducted by Wang TJ et al in Taiwan showed that patients
with CKD had significantly higher prevalence of retinal disorders and other eye
problems i.e. 16.62% 23. Moreover, it has already been suggested
for regular retinal examination in the patients of CKD because CKD is
associated with progression of retinal micro vascular changes 24.With
the age there is degeneration of macula but with CKD, there is early macular
degeneration occurs25.

Cardiovascular   events are the major causes of mortality in
CKD patients. Ana C. Ricardo et al conducted a study in USA for knowing major
causes of mortality and compared normal with those having CKD and retinopathy and
found that cardiovascular or other causes of mortality were 1.02% with
retinopathy, 1.52% with CKD, and 2.39% with both CKD and retinopathy 26. So retinopathy can be
predictor for defining the prognosis of cardiovascular events in CKD patients. Presence of retinopathy reflect early
subclinical damage in the renal microvasculature which may lead to the
subsequent development of renal disease so Retinal
microvscular changes may precede the development of overt proteinuria and renal
failure and.  Intervention at this level may retard the
progression of CKD and associated complications.

This study will help us to get idea
about the correlation of retinopathy with various stages of CKD and its
management to be done.