Advances In Insulin Resistance And Its Correlation With Chronic Kidney Disease

Insulin resistance is a state in which a smaller reponse with normal amount of insulin, including sensitivity and (or) responsivity becoming dull, and the former state in which a greater than normal amount of insulin is requied to alicit a quantitatively normal reponse, then the latter in which the normal reponse will never be available.Chronic Kidney Disease (CKD) is a conception being raised recent years.According to the suggesstion of Kidney Disease:Improving Global Outcomes (KDIGO), CKD, which has replaced the before conceptions such as "Chronic Renal Failure" and" Chronic Kidney Injure", should include all the chronic kidney disease being induced by all causes.The conception is not only a change of term, but also represents a breakthrough of studying Nephrology. Once CKD progresses into the final stage, replacement therapy will be the only way. This regulation reminds clinical staff, espacially the nephrologist,of that the theatment to CKD as soon as possible is important,and we should treat it as a whole to improve clinical effects.There are evidences, including epidemiology and others, show that IR and CKD are correlative, and which are not enough. The existing evidences have not revealed the mechanism about the correlation, so we should study and collect enough evidencesNow, foregone causes to IR involve a variety of factors such as heredity, environment, diet, lifestyle, emotion and infection, which maybe include as following:1)Metal obesity,IR even and GDM;2)diet, especially high fat,is significant for it,but the high protein is not clear;3)obesity, especially the abdominal obesity;4)unhealthy lifestyle:lifestyle with a deficiency of sport may lead to IR by decreasing the GLU transporters on the muscle.5)emotion, especially the depression.6) the change of hormone:the change of hormone during the puberty, menopause and even menstrual cycle in girls can aggravate the degree of IR, and which increases the difficulty for the diagnosis of IR;7)pregnancy:pregnacy can induce or aggravate IR;8)a lack of microelement:there are some evidences which confirm that a lack of microelement such as Zn and Mg is correlated to IR;9)vitamin D insufficiency;10)smoking:the unhealthy lifestyle with smoking may be the factor correlated to IR;11) injection of bactria:the injection of Helicobacter pylori has been proved to be correlated to IR;12)The toxicity of high serum glucose:the state of high serum glucose being caused by a variety of factors can all stimulatesβ Cell of islet, and then induce IR. Besides, that the degree of IR will varies along with the different races reminds us of that the standard of IR should also be varies along with the different condition.The pathological mechanisms of IR include:1) RAAS being stimulated;2, injury of Endothelial cells;3, oxidative stress;4, the reduction of insulin receptor;5, dysfunction of adipose tissue;6, chronic inflammation;7, the disordered secretion of insulin; IR can induce or aggravate CKD by immediate action or other pathophysiology ways on kidney, and in which specific mechanisms are as following:1)chronic inflammation:Hyperinsulinism could lead to the release of IGF-1, and which leads the mesenchyme of kidney to fibrosis;2)RAAS being stimulated:Hyperinsulinism could stimulate RAAS, and then result in the hyperperfusion/hypertransfution and high filtration of kidney,while water and Na rention is also caused, then CKD is aggravated;3)Haemodynamic control of renal organ blood flow and local glomerular blood flow:there is evidence that IR would change the stable state of haemodynamics, and which will reduce the renal organ blood flow as the GFR will also decrease.4)nervus sympatheticus being stimulated:IR and hyperinsulinmia could also stimulate the nervus sympatheticus,which could act on the kidney directly and influence the renal organ blood flow, and then the result is that CKD would progress.5)Insulin receptor will appear on almost all the cells of the nephron, so IR could act on the kidney cells such as podocyte,endotheliocyte and mesangial cell, directly, which will lead to albuminuria, metabolicdisorder of water and sodion and renal tubular necrosis, and then the CKD will progress.The understanding of TCM on IR include details as follows:the location of the disease is in tri-jiao,which includes Lung in the upper part of the body, Spleen and Stomach in the middle, Liver and Kidney in the bottom. The characters of the disease include weak and strong. The weak side almost include spleen and kidney,while the strong factors include fire, phlegm, that the qi of liver is stagnant, and the blood stasis.There are evidences that Metformin and PPARγ could defer the course of CKD as curing IR,but, the studies are still the stages of observation. And the systematic treatment for curing IR has not been founded.Cliniclly, Tranditional Chinese medicine has made certain curative effect to improve the IR. A variety of single tranditional Chinese medicine and drugs have been proved to be used to improve the IR. They reveals that improving IR of tradtional Chinese medicine is multi-ingredients of,multi-channel and many targets.And compared with western medicine,they are relatively safe, small side effects. But,most of the present research still stays a stage of preliminary study such as the clinical observation. And the long-term data as well as the evidences relating to the mechanism and characteristics is still lack. In terms of these, the use of tranditional Chinese medicine in improving IR still needs clinical study with a large number of samples and randomized controlled trials to conduct the clinics.