期刊
CARDIORENAL MEDICINE
卷 8, 期 1, 页码 41-49出版社
KARGER
DOI: 10.1159/000479801
关键词
Chronic kidney disease; Insulin resistance; Renin-angiotensin-aldosterone system
资金
- Department of Veterans affairs
- Veterans Affairs Merit System [0018, BX003391]
- National Institutes of Health [RO1 HL73101-10A, RO1 HL107910-01]
Insulin resistance is a central component of the metabolic dysregulation observed in obesity, which puts one at risk for the development of type 2 diabetes and complications related to diabetes such as chronic kidney disease. Insulin resistance and compensatory hyperinsulinemia place one at risk for other risk factors such as dyslipidemia, hypertension, and proteinuria, e.g., development of kidney disease. Our traditional view of insulin actions focuses on insulin-sensitive tissues such as skeletal muscle, liver, adipose tissue, and the pancreas. However, insulin also has distinct actions in kidney tissue that regulate growth, hypertrophy, as well as microcirculatory and fibrotic pathways which, in turn, impact glomerular filtration, including that governed by tubuloglomerular feedback. However, it is often difficult to discern the distinct effects of excess circulating insulin and impaired insulin actions, as exist in the insulin resistance individual, from the associated effects of obesity or elevated systolic blood pressure on the development and progression of kidney disease over time. Therefore, we review the experimental and clinical evidence for the distinct impact of insulin resistance on kidney function and disease. (c) 2017 S. Karger AG, Basel
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