In a previous study [60], serum TNF-α level was not associated with the presence and severity of microalbuminuria, otherwise, the level of urinary TNF-α was only significantly influenced by albumin-creatinine ratio (ACR), although other factors had been included in the multivariate analysis: age, duration of diabetes, BMI, history of cardiovascular disease, presence of retinopathy, hypertension, and HbA1c levels. This evidence concerns the gene ALB and retinal disorder.