Utility of Albumin Creatinine Ratio (Acr) in Monitoring Diabetic Retinopathy and Nephropathy

Objective: To evaluate Albumin Creatinine Ratio (ACR) as a screening marker for detection of early diabetic retinopathy in parallel with diabetic nephropathy. Study Design: Comparative cross sectional study. Place and Duration of Study: Department of Ophthalmology and Chemical Pathology & Endocrinology, Combined Military Hospital, Multan, from Jul 2017 to Jul 2019. Methodology: A total of 386 diagnosed patients of type II diabetes mellitus who reported for follow up and monitoring in Combined Military Hospital Multan, underwent initial screening with urine dip strip, if protein positive patients were excluded if negative patients were included in the study. Urinary albumin creatinine ratio was calculated as mg/mmol of creatinine. For staging of diabetic retinopathy; participants underwent ocular examinations. Pearson correlation was performed and ROC was constructed at different cut-offs. Results: Out of the 386 (100%) patients with type II diabetes 284 (74%) had albumin creatinine ratio <3 mg/mmol and 102 (26%) had micro albuminuria i.e. albumin creatinine ratio 3-30 mg/mmol. Among normal albumin uric cases (284) only 52 (18%) patients had mild to moderate non-proliferative diabetic retinopathy. Conclusion: Albumin creatinine ratio is associated with severity of diabetic retinopathy. Since diabetic retinopathy stages have been identified in normal albumin uric range, there is need to determine a definite cut off value (<3 mg/mmol) of ACR for using it as a screening marker for diabetic retinopathy.