I have had type 1 diabetes since 1958 and have proliferative retinopathy, which caused total vision loss in one eye despite laser treatment. My other eye has slight vision loss. My ophthalmologist is surprised that I have no kidney damage. I know both conditions involve damage to small blood vessels. Is it rare to have so much damage to my eyes but none to my kidneys?

Although eye and kidney disease can occur simultaneously in an individual, it is not the case that all patients that have retinopathy have advanced nephropathy from diabetes. Roughly 25% of patients develop nephropathy by 15 to 20 years of type 1 diabetes. Risk factors include hypertension, family history, and poor blood sugar control. However, after those 20 years, the development of nephropathy is uncommon. Therefore, if you have developed your retinopathy late in your disease process, you may be one of the lucky individuals that escaped kidney disease. With retinopathy, there is a relationship whereby most individuals develop this condition if followed long enough. This is unlike nephropathy. There are many things we do not know about nephropathy and retinopathy risk. Clearly, there must be genetic predisposition, as well as genetic protection.

I would also add that most people define the presence of nephropathy by albumin in the urine and a decrease in the estimated glomerular filtration rate, calculated from the serum creatinine. It is important to note that these are not the most precise methods for quantifying kidney damage. For now, it is important you have close eye follow-up and good control of your blood pressure and blood sugar.

JTL