Why does Nephrology Department need to perform fundus examination?

As the saying goes, "eyes are windows to the soul." In clinical practice, especially for nephrologists, "eyes are windows to the kidneys." The fundus is a window for evaluating microvascular lesions throughout the body. Fundus examination is a simple and non-invasive examination that can determine whether there are lesions in the blood vessels of many chronic diseases at an early stage. Through professional instruments, doctors can directly observe the arteries, veins, and capillaries on the retina, and evaluate the state of microcirculation of the body's organs based on the distribution and condition of these microvessels.

01Diabetic nephropathy

Diabetic nephropathy and diabetic retinopathy often occur simultaneously, and they are both complications of diabetic microangiopathy. By examining the fundus of diabetic patients, their kidney damage can be inferred without renal puncture biopsy. Diabetic retinopathy is divided into the following six stages: Stage I is limited to venous dilatation or microaneurysm, small bleeding spots; Stage II has hard exudates and hemorrhagic spots; Stage III has soft exudates and hemorrhagic spots; Stage IV has new blood vessels and vitreous hemorrhage; Stage V has new blood vessels and fibrosis; Stage VI is complicated by retinal detachment.

02Hypertensive nephropathy

Hypertensive nephropathy is renal arteriosclerosis and renal function damage caused by hypertension, which is more common in middle-aged and elderly people. It is mainly caused by long-term hypertension and is also common in young people.

Hypertensive retinopathy is a fundus lesion caused by long-term poor control of hypertension, including optic disc edema, sclerosis and occlusion of retinal arterioles, retinal vein obstruction, exudation and edema in the macular area, which seriously affect the patient's vision. In this way, by examining the fundus of hypertensive patients, their kidney damage can be inferred without renal puncture biopsy.

03 Tubulointerstitial nephritis uveitis syndrome (TINU)

This is a clinically uncommon multi-system autoimmune disease that mainly affects the kidneys and eyes, and is mainly diagnosed in children and adolescents. The ocular manifestations of this disease are bilateral non-granulomatous anterior uveitis, accompanied by choroidal lesions, retinal neuritis, optic disc edema, macular edema, retinal detachment, scleritis, and symptoms such as redness, photophobia, and tearing. Renal manifestations often appear before ocular symptoms, often manifested as idiopathic acute tubulointerstitial nephritis, acute renal failure, proteinuria, hypokalemia, etc. In addition to renal and ocular manifestations, other organs may be affected, such as hearing loss, vestibular failure, thyroiditis, lymphocytic alveolitis, arthritis, etc.

04Systemic arteriosclerosis

The degree of retinal arteriosclerosis in the fundus can reflect the condition of systemic vascular arteriosclerosis. If fundus examination reveals hardening and stenosis of the retinal arteries, it often indicates that there are multiple hardening and stenosis of blood vessels throughout the body.

Literature reports: Patients with retinal arteriosclerosis have a significantly higher risk of developing coronary artery atherosclerosis and heart failure than other people. The degree of fundus microvascular arteriosclerosis is positively correlated with the incidence of hyperlipidemia and cardiovascular and cerebrovascular diseases (such as coronary heart disease, aortic sclerosis, and cerebral arteriosclerosis).

Finally, the final diagnosis of kidney disease still depends on renal puncture biopsy, and the most effective treatment plan should be formulated based on the pathological results.