Wijkström and colleagues1 performed a kidney biopsy study on 19 male sugarcane workers with suspected Mesoamerican nephropathy. They used De Galantha staining on paraffin-embedded tissue to detect urate crystals. No uric acid crystals were found. I have several concerns regarding the apparent absence of urate crystals in the kidney biopsy specimens because urate crystalluria is not uncommon in sugarcane workers.2