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[Insulin resistance in kidney diseases]
V Spustová1, K Stefíková, L Hust'avová
1Klinika farmakoterapie Ustavu preventívnej a klinickej medicíny, Bratislava.
Abstract:
Insulin resistance (IR) is found in different kidney diseases in almost half the patients with mild to medium severe disorders of renal functions; in advanced renal failure it is almost constant. In addition to pathogenetic mechanisms known in other diseases of Reaven's syndrome it has some specific features: Already in the early stages calcitriol production is impaired, and if the calcium intake is not increased and calcitriol is not substituted, secondary hyperparathyroidism with osteodystrophy develops. The intracellular concentration of free Ca increases and the intracellular concentration of free Mg declines. Activation of the renin angiotensin system (RAS) stimulates Ca release from intracellular reserves and potentiates thus the cumulation of free Ca in the cytoplasm. Magnesium plays a special part as it influences glucose utilization by several mechanisms. Diagnosis, prevention and therapy of IR are an essential part of comprehensive prevention of progressing nephropathies with a predicted decline of patients requiring dialysis by cca 30% by the year 2000. This calls, however, for concentrated efforts of all health professionals.
Insights
Insulin resistance (IR) is common in kidney disease, impacting calcium and magnesium levels. Early diagnosis and treatment of IR are crucial for preventing kidney disease progression and reducing dialysis needs.
Area of Science:
- Nephrology
- Endocrinology
- Metabolic Disorders
Context:
- Insulin resistance (IR) is prevalent in various kidney diseases, affecting nearly half of patients with mild to moderate renal dysfunction and becoming nearly constant in advanced renal failure.
- Specific features of IR in kidney disease include impaired calcitriol production even in early stages, potentially leading to secondary hyperparathyroidism and osteodystrophy if calcium intake is not increased or calcitriol not supplemented.
- Renal IR involves altered intracellular calcium (Ca) and magnesium (Mg) concentrations, with increased free Ca and decreased free Mg.
Purpose:
- To highlight the specific pathogenetic mechanisms of insulin resistance in kidney disease.
- To emphasize the role of impaired calcitriol production, mineral imbalances (calcium and magnesium), and the renin-angiotensin system (RAS) in renal insulin resistance.
- To underscore the importance of diagnosing, preventing, and treating insulin resistance as a key component in managing progressive nephropathies.
Summary:
- Insulin resistance is a significant complication in kidney disease, characterized by impaired calcitriol metabolism, abnormal intracellular calcium and magnesium levels, and activation of the renin-angiotensin system.
- Magnesium plays a critical role in glucose utilization, and its decline in renal disease exacerbates insulin resistance.
- Early identification and management of IR are vital for mitigating the progression of kidney disease and potentially reducing the need for dialysis.
Impact:
- Effective management of insulin resistance can significantly contribute to the comprehensive prevention of progressive nephropathies.
- Addressing IR in kidney disease patients may lead to a substantial decrease in the number of patients requiring dialysis.
- Integrated efforts from healthcare professionals are essential for implementing effective strategies for the diagnosis, prevention, and therapy of insulin resistance in nephropathic patients.