Glomerular Lesions and Microalbuminuria in Diabetes

To the Editor: In their study, Chavers et al. (April 13 issue)¹ address a crucial point regarding the validity of using the level of urinary albumin excretion to predict the likelihood of overt diabetic nephropathy in a given patient. However, their conclusion that microalbuminuria is not a predictive test for overt nephropathy since there is a “completely overlapping range of glomerular lesions, from almost normal glomeruli to a degree of abnormality bordering on that regularly associated with overt nephropathy” is not completely supported by their data. Their results may be interpreted to show that glomerular abnormalities, particularly fractional mesangial expansion,.