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September 20, 1976

Nature and Nurture in Diabetic Glomerulopathy

JAMA. 1976;236(12):1387-1388. doi:10.1001/jama.1976.03270130049032

When we differentiate hereditary from environmental factors in disease, we generally do so at the level of the individual patient. Can similar differentiation apply to an individual organ and its metabolic environment?

This question arises when an organ bears the brunt of pathologic damage in the course of a systemic disease. Such was the case not too long ago with hypertension. Some authorities believed that lowering the blood pressure would not prevent or arrest the pathologic changes in the affected organs because these changes did not result from hemodynamic stresses but inhered in the organs themselves as an integral part of the disease. Experience has since proved the fallacy of this belief.

Can experience shed similar light on organ involvement in diabetes, particularly on diabetic nephropathy? Is the diseased kidney of an insulin-dependent diabetic patient earmarked for characteristic pathologic changes by a heritable diabetic trait, or are these changes secondary