Vnitr Lek 1995, 41(2):129-135

[Insulin resistance in kidney diseases].

V Spustová, K Stefíková, L Husťavová, R Dzúrik: Klinika farmakoterapie Ustavu preventívnej a klinickej medicíny, Bratislava.

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.