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In Reply: In response to Dr Kida, we are unaware of studies of atubular glomeruli among patients with diabetes and kidney disease but without albuminuria,¹ but this is certainly an area that should be further investigated.

We disagree with Dr Onuigbo that a random single eye examination underestimated diabetic retinopathy in our data from the Third National Health and Nutrition Examination Survey (NHANES III). In the Wisconsin Epidemiologic Study of Diabetic Retinopathy, only 9% of the 991 subjects had diabetic retinopathy in 1 eye, while 63% had bilateral disease and the remaining subjects had no retinopathy (Ronald Klein, MD, MPH, Department of Ophthalmology and Visual Sciences, University of Wisconsin Medical School, Madison, unpublished data, November 4, 2002). We believe that a more likely reason for the higher incidence of retinopathy reported by Gall et al² and Schwartz et al³ is referral bias. Gall et al studied patients attending a diabetes . . . [Full Text of this Article]

Holly Kramer, MD, MPH
Department of Epidemiology and Preventive Medicine
Loyola University Medical Center
Maywood, Ill

Chi-yuan Hsu, MD, MSc
Division of Nephrology
University of California at San Francisco

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