Glucose metabolism, insulin resistance, and renal pathology in non-diabetic chronic kidney disease.
BACKGROUND
The relation between insulin resistance and atherosclerosis is widely recognized, but it remains unknown whether glucose metabolism/insulin resistance is related to renal pathology in humans.


METHODS
We quantitatively evaluated pathological changes in the glomeruli, tubulointerstitium, and vessels in renal biopsy specimens from 23 patients with non-diabetic chronic kidney disease (CKD), all of whom took a 75-gram oral glucose tolerance test. We correlated the renal pathological changes with fasting plasma glucose (FPG), fasting plasma insulin, 2-hour plasma glucose (2-h PG), 2-hour plasma insulin (2-h PI), homeostasis model assessment of insulin resistance (HOMA-IR), and body mass index.


RESULTS
HOMA-IR exceeded 1.73 in 11 patients (47.8%), and 2-h PI exceeded 64.0 microU/ml in 14 (60.9%). FPG significantly correlated with interstitial fibrosis (r = 0.532, p = 0.009). The significance was marginal in the correlation between FPG and tubular atrophy and arterio-arteriolosclerosis. Statistically significant correlation was also found between 2-h PG and arterio-arteriolosclerosis (r = 0.422, p = 0.04) and between HOMA-IR and interstitial fibrosis (r = 0.416, p = 0.04).


CONCLUSIONS
Although precise mechanisms remain unknown, glucose metabolism/insulin resistance seem to play pathogenic roles in formation and progression of renal pathological changes, especially tubulointerstitial and vascular lesions, in non-diabetic CKD.
Ikee
Ryota
R
Department of Nephrology and Kidney and Dialysis Center, Shonan Kamakura General Hospital, Kamakura, Japan. ryota.ikee@tokushukai.jp
Hamasaki
Yoshifumi
Y
Oka
Machiko
M
Maesato
Kyoko
K
Mano
Tsutomu
T
Moriya
Hidekazu
H
Ohtake
Takayasu
T
Kobayashi
Shuzo
S
D000328:Adult; D000368:Aged; D001707:Biopsy, Needle; D001786:Blood Glucose / Q000378:metabolism*; D015992:Body Mass Index; D015331:Cohort Studies; D003928:Diabetic Nephropathies / Q000503:physiopathology; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D005951:Glucose Tolerance Test; D006801:Humans; D007150:Immunohistochemistry; D007333:Insulin Resistance; D007676:Kidney Failure, Chronic / Q000473:pathology* / Q000503:physiopathology*; D007677:Kidney Function Tests; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011336:Probability; D012307:Risk Factors; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D016482:Urinalysis
D001786:Blood Glucose