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Causes of Renal Failure in Patients With Type 2 Diabetes Mellitus
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To the Editor: Dr Kramer and colleagues1 found an absence of both retinopathy and albuminuria in 30% of adult patients with type 2 diabetes and CRI. Thus, they concluded that diabetic glomerulosclerosis would not account for a significant proportion of CRI in patients with diabetes.
I am concerned, however, that they examined only 1 eye in each patient. Other studies that examined both eyes have found higher rates of albuminuria2 and retinopathy3 in patients with diabetic CRI. The results of Kramer et al are also inconsistent with those of Nosadini et al4 who reported that diabetic glomerulosclerosis was found in 100% of their patients with diabetes and CRI, and that none had any definable nondiabetic renal disease. None of these patients had macroalbuminuria, and all had normal GFR.
Furthermore, type 2 diabetic nephropathy is a heterogeneous entity. Tsalamandris et al5 reported that of 40 patients with diabetes, 15 developed progressive . . . [Full Text of this Article]
Macaulay A. C. Onuigbo, MD, MSc
Department of Nephrology
Luther Midelfort-Mayo Health System
Eau Claire, Wisc
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