Insulin resistance in chronic uremia
Gianfranco Guarnieri1, Michela Zanetti, Pierandrea Vinci
1Department of Clinical, Morphological, and Technological Sciences, Clinica Medica, University of Trieste, Trieste, Italy. guarnier@units.it
Summary
Insulin resistance in chronic uremia worsens patient outcomes. Understanding its complex causes, including obesity and uremia-specific factors, is key to developing better treatments.
Area of Science:
- Nephrology
- Endocrinology
- Metabolic Diseases
Background:
- Insulin resistance is common in chronic uremia, increasing morbidity and mortality.
- It contributes to protein-energy wasting, atherosclerosis, and cardiovascular death.
- Obesity is a growing risk factor for chronic kidney disease and insulin resistance.
Purpose of the Study:
- To explore the multifactorial causes of insulin resistance in chronic uremia.
- To highlight the role of obesity and altered adipokines in insulin resistance.
- To identify uremia-specific factors contributing to insulin resistance.
Main Methods:
- Review of existing literature on insulin resistance in chronic uremia.
- Analysis of the impact of obesity on insulin resistance in chronic kidney disease patients.
- Examination of hormonal, inflammatory, and oxidative stress factors in uremia.
Main Results:
- Obesity is an independent risk factor for chronic kidney disease and insulin resistance.
- Adipose tissue and adipokines play a role in insulin resistance in obese uremic patients.
- Hormonal imbalances, acidosis, inflammation, and oxidative stress contribute to insulin resistance in nonobese uremic individuals.
Conclusions:
- Understanding the causes of insulin resistance in chronic uremia is crucial.
- Effective therapeutic strategies can be designed by further elucidating these causes.
- Reducing uremia-associated morbidity and mortality is a primary goal.
Related Concept Videos
01:24Type II Diabetes II: Pathophysiology
PathophysiologyType 2 diabetes mellitus (T2DM ) is a chronic metabolic disorder characterized by insulin resistance and progressive pancreatic β-cell dysfunction, leading to impaired glucose homeostasis. It results from interactions among genetic predisposition, environmental factors, and metabolic stressors, such as overnutrition and a sedentary lifestyle.Insulin Resistance and Glucose DysregulationEarly T2DM involves insulin resistance in skeletal muscle, adipose tissue, and the liver.
01:28Diabetic Nephropathy
Definition Diabetic nephropathy is a chronic kidney complication that results from prolonged hyperglycemia.Prevalence It is the most common cause of chronic kidney disease (CKD) and end-stage renal disease (ESRD) worldwide, affecting up to half of individuals with diabetes.Pathophysiology • Sustained hyperglycemia triggers multiple hemodynamic and metabolic changes in the kidney. • Early in the disease, increased renal blood flow and glomerular hyperfiltration occur due to afferent arteriolar...
01:24Chronic Kidney Disease II: Clinical Manifestations
Chronic Kidney Disease (CKD) progressively impairs multiple body systems due to the accumulation of uremic toxins, which disrupt cellular functions across various organs.Neurologic symptomsNeurologic symptoms often arise early in CKD, as uremic toxin buildup drives changes in cognitive and motor functions. Patients frequently experience fatigue, headache, confusion, difficulty concentrating, and, in severe cases, seizures. Peripheral neuropathy commonly manifests as burning sensations in the...
01:16Insulin: Dosing Regimen and Adverse Effects
Insulin-replacement therapy usually includes both long-acting insulin (basal) and short-acting insulin (to cater to postprandial needs). In a diverse group of type 1 diabetes patients, the average daily insulin dose is typically 0.5-0.7 units/kg body weight. However, obese patients and pubertal adolescents may need more due to insulin resistance.
The basal dose constitutes about 40%-50% of the total daily dose, with the rest as premeal insulin. The mealtime insulin dose should mirror...
The basal dose constitutes about 40%-50% of the total daily dose, with the rest as premeal insulin. The mealtime insulin dose should mirror...
01:29Hyperglycemia
Hyperglycemia is an abnormally high blood glucose level. It is diagnosed by fasting glucose ≥126 mg/dL, 2-hour oral glucose tolerance test (or OGTT) ≥200 mg/dL, random glucose ≥200 mg/dL with symptoms, or HbA1c ≥6.5%. However, HbA1c results may be unreliable in certain conditions, such as anemia or hemoglobinopathies, and the diagnosis should be confirmed unless classic symptoms are present. Postprandial hyperglycemia is typically considered significant when glucose levels exceed 180 mg/dL two...
01:25Chronic Kidney Disease I: Introduction
Chronic Kidney Disease (CKD) arises when the kidneys progressively lose their ability to function, ultimately leading to end-stage renal disease. At this advanced stage, the kidneys can no longer filter waste or maintain essential body functions, requiring renal replacement therapy (RRT) through dialysis or a kidney transplant for survival.Early-stage chronic kidney disease and detection challengesIn CKD's early stages, symptoms often remain absent because healthy nephrons compensate for...