Postprandial hyperglycemia and hyperinsulinemia associated with renal arterio-arteriolosclerosis in chronic kidney disease

作者：Ikee Ryota^*; Honda Kenjiro; Ishioka Kunihiro; Oka Machiko; Maesato Kyoko; Moriya Hidekazu; Hidaka Sumi; Ohtake Takayaku; Kobayashi Shuzo

来源：Hypertension Research, 2010, 33(5): 499-504.

DOI：10.1038/hr.2010.22

• chronic kidney disease
• impaired glucose tolerance
• insulin resistance
• renal arterio-arteriolosclerosis
• tubulointerstitial injury

Hypertension has an important function in the formation of renal arterio-arteriolosclerosis. However, renal arterio-arteriolosclerosis is sometimes found in biopsy specimens of normotensive patients, which indicates unknown factors may contribute to renal arterio-arteriolosclerosis. In this study, we aimed to evaluate the effects of glucose metabolism/insulin resistance on renal arterio-arteriolosclerosis. Forty-eight patients with biopsy-proven non-diabetic chronic glomerular disease were included. Renal arterio-arteriolosclerosis was evaluated as the percentage of vessels showing hyaline changes or wall thickening. We correlated renal arterio-arteriolosclerosis with clinical parameters including indices obtained by 75 g oral glucose tolerance test. Of the 48 patients, 30 had hypertension. The results of univariate analysis showed significant association of renal arterio-arteriolosclerosis with hypertension, increased serum creatinine (S-Cr), hypertriglyceridemia, increased 2-h plasma glucose (PG) and increased 2-h plasma insulin (PI). In stepwise multiple regression analysis, hypertension (beta=0.344, P-0.009), S-Cr (beta-0.287, P-0.03) and 2-h PG (beta-0.274, P-0.03) were independently associated with renal arterio-arteriolosclerosis. Eleven of the 30 hypertensive patients did not have renal arterio-arteriolosclerosis. The hypertensive patients with renal arterio-arteriolosclerosis showed significantly higher 2-h PG (134 +/- 25 vs. 106 +/- 26 mg per 100 ml, P=0.008) and higher 2-h PI (67.7 +/- 34.9 vs. 48.3 +/- 30.0 mu U ml(-1), P=0.04) compared with those without renal arterio-arteriolosclerosis, but the difference in S-Cr was not significant. Postprandial hyperglycemia and hyperinsulinemia may contribute to the formation of renal arterio-arteriolosclerosis independently of hypertension. Hypertension Research (2010) 33, 499-504; doi: 10.1038/hr.2010.22; published online 26 February 2010

• 出版日期2010-5