To the Editor.—
The article by Kussman et al (236:1861, 1976) is useful in predicting the course of renal failure in the juvenile diabetic. The data adapted from Goldstein1 (illustrating the time course of the rise in BUN and creatinine values) do not, however, support the hypothesis that there is an acceleration in the rate of deterioration of renal function. Early in the course of renal failure, large decrements in glomerular filtration are accompanied by small increases in the BUN and creatinine levels, while in late renal failure the inverse holds: small decrements in glomerular filtration are accompanied by large increases in the BUN and creatinine levels. The data presented demonstrate this relationship and are more consistent with a linear deterioration in glomerular filtration. It is true, however, that complications are seen with increasing frequency in late renal failure.
Martin P. Diabetic Nephropathy. JAMA. 1977;237(8):765. doi:10.1001/jama.1977.03270350025006
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