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October 8, 2003

Causes of Renal Failure in Patients With Type 2 Diabetes Mellitus—Reply

Author Affiliations

Letters Section Editor: Stephen J. Lurie, MD, PhD, Senior Editor.

JAMA. 2003;290(14):1855-1856. doi:10.1001/jama.290.14.1855-a

To The Editor: Dr Kramer and colleagues1 reported that among adults with type 2 diabetes and renal failure (defined as a glomerular filtration rate [GFR] less than 60mL/min per 1.73 m2 body surface area), 30% had neither retinopathy nor albuminuria.

The concept of "atubular glomeruli" could help account for the lack of vascular damage in the eye or kidney despite the apparent presence of renal injury. The concept proposes that damage occurs first at the renal tubule and then later at the glomerulus.2 Collapse of the tubule can lead to the obstruction of the tubule lumen, and thus prevents efflux of the glomerular filtrate from the Bowman capsule.2 It is possible that atubular glomeruli would be found in patients with type 2 diabetes and chronic renal insufficiency (CRI), but without retinopathy or albuminuria.

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