Muscle capillary basement membrane (MCBM) thickening has been considered to reflect microvascular changes in other tissues in diabetes mellitus. To explore the relationships between MCBM width and nephropathy, 27 patients aged 22-55 yr with type I diabetes for 14-33 yr were studied with creatinine clearances, urinary albumin excretion rates, multiple blood pressure measurements, glycosylated hemoglobin measurements, and renal and quadriceps muscle biopsies that were evaluated using standard stereologic techniques. MCBM width did not correlate with age, duration of diabetes, creatinine clearance, urinary albumin excretion, or fractional volume of the glomerular mesangium. MCBM width did correlate, although weakly, with glomerular basement membrane width (r = 0.47) and glycosylated hemoglobin (r = 0.44). There was no difference in MCBM width between patients with and without clinical nephropathy. Patients with normal fractional volume of mesangium exhibited a full range of MCBM width. Thus, while MCBM width may reflect glycemic control and glomerular basement membrane thickening, it does not release to the functional or structural renal changes associated with progressive diabetic nephropathy.