LETTERSpopulation. Diabetologia 1993; 36:150–154.

2. McQuay HJ. Antidepressants andchronic pain. Br Med J 1997; 314:763–764.

3. Worsley AP. New combination ther-apy for diabetic neuropathy. DiabetesDebate 1997; 3: 20.

4. Dejgaard A. Pathophysiology andtreatment of diabetic neuropathy. Dia-betic Med 1998; 15: 97–112.

Parental Hypertension and Risk of Dia-betic Nephropathy

Roglic et al.1 report a weak associationbetween a parental history of hypertensionand the presence of microalbuminuria inthe EURIODIAB cohort, citing an oddsratio of 1.3 for the risk of albuminuria inthose with and without a parental historyof hypertension. By contrast, Krolewski etal.2 have suggested that the influence ofparental hypertension is far more power-ful, reporting an odds ratio of 3.4 for thelikelihood of nephropathy in the presenceof parental history of hypertension. Thereare methodological differences betweenthese studies, not least the difference in

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1998 John Wiley & Sons, Ltd. Diabet. Med. 15: 797–798 (1998)

the degree of renal disease. As discussedby Roglic,1 some of their subjects withmicroalbuminuria may not later progressto overt nephropathy.

We examined parental history of hyper-tension in 118 patients with Type 1diabetes and established nephropathy.The patients had advanced renal disease:87 (74 %) receiving renal replacementtherapy (either transplant or dialysis) anda further 31 (26 %) had serum creatinineof greater than 120 mmol l−1 with elevatedurinary albumin concentration(. 300 mg l−1). We compared these casesto a control group of 118 Type 1 patientsof at least 14 years duration of diabetes,without evidence of microalbuminuria ornephropathy and matched for age, sex,and diabetes duration.

In our group 32 % of those with nephro-pathy compared to 27 % of controls hadat least one parent with a history ofhypertension (Fisher’s exact test P = NS).Thus, in a group of patients with moresevere renal disease the influence of aparental history of hypertension is stillnot particularly marked. We support theconclusions of Roglic et al. and suggestthat inherited factors other than hyperten-sion may explain the influence of familyhistory on diabetic renal disease.

R. S. Lindsay1, J. A. Little1, A. J. Jaap1,P. L. Padfield2, J. D. Walker1, K. J. Hardy3

1Department of Diabetes, Royal Infirmaryof Edinburgh, Edinburgh EH3 9YW2Department of Medicine, Western Gen-eral Hospital, Edinburgh EH4 2XU3Department of Medicine, Whiston Hospi-tal, Prescot, Merseyside L35 5DR

References

1. Roglic G, Colhoun HM, Stevens LK,Lemkes HH, Manes C, Fuller JH, andthe EURODIAB IDDM ComplicationsStudy Group. Parental history ofhypertension and parental history ofdiabetes and microvascular compli-cations in insulin-dependent diabetesmellitus: the EURODIAB IDDM Com-plications study. Diabetic Med 1998;15: 418–426.

2. Krolewski AS, Canessa M, WarramJH, Laffel LM, Christlieb AR, KnowlerWC, Rand LI. Predisposition to hyper-tension and susceptibility to renaldisease in insulin-dependent diabetesmellitus. N Engl J Med 1988; 318:140–145.