When last commented on in the Archives two years ago,1 the diabetic renal-retinal syndrome was viewed as a usually serious and often devastating complication of long-standing diabetes for which near-term improvement in prognosis was likely. At that time, it was noted that about half of insulindependent diabetics experience renal failure in a mean of 20 years. Survival of treated uremic diabetics was dismal, with only one in five patients surviving beyond two years of peritoneal dialysis and about one in two living longer than three years after a cadaveric kidney transplant or when sustained by hemodialysis.
Interest in diabetic nephropathy since then has been intensified by numerous articles indicating that glomerulosclerosis, the major renal pathological finding in protracted diabetes, is a consequence of hyperglycemia per se. Evidence supporting this contention is drawn from two sources—animal models of diabetes and the fate of renal allografts from nondiabetic donors to diabetic