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Predictors of Kidney Disease in Diabetic, Hypertensive Patients

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Diabetes and Hypertension

Part of the book series: Contemporary Diabetes ((CDI))

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Abstract

The underlying mechanisms of insulin resistance that contribute to the development of overt type 2 diabetes mellitus also contribute to endothelial dysfunction and hypertension that are related to chronic kidney disease (CKD). The hyperinsulinemic state is associated with inappropriate activation of the renin–angiotensin–aldosterone system (RAAS) and sympathetic nervous system that leads to sodium and extracellular fluid expansion as well as increased tissue inflammation and oxidative stress. Moreover, mounting evidence in recent years supports that insulin resistance is independently associated with proteinuria and the development of CKD. Elevations in circulating insulin and impairments in insulin-dependent metabolic signaling pathways are associated with upregulation of angiotensinogen expression contributing to the maladaptive effects of angiotensin II and aldosterone on the kidneys. Thereby, aggressive management of risk factors, using both pharmacologic and non-pharmacological strategies, is essential to diminish loss of kidney function. Thereby we will review the mechanisms leading to kidney disease in insulin-resistant individuals.

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Authors and Affiliations

  1. Department of General Internal Medicine, University of Missouri-Columbia School of Medicine, One Hospital Drive, DC043.00, Columbia, MO, 65212, USA

    Jaya P. Buddineni M.D.

  2. Division of Nephrology and Hypertension, Harry S. Truman VA Medical Center, Columbia, MO, 65211, USA

    Kunal Chaudhary M.D. & Adam Whaley-Connell D.O., M.S.P.H.

  3. Department of Internal Medicine, University of Missouri-Columbia School of Medicine, Columbia, MO, 65211, USA

    Kunal Chaudhary M.D. & Adam Whaley-Connell D.O., M.S.P.H.

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  1. Jaya P. Buddineni M.D.
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  2. Kunal Chaudhary M.D.
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  3. Adam Whaley-Connell D.O., M.S.P.H.
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Correspondence to Adam Whaley-Connell D.O., M.S.P.H. .

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Editors and Affiliations

  1. County Hospital, Division of Endocrinology,, SUNY-Downstate and Kings, 450 Clarkson Ave., Brooklyn, 11203, New York, USA

    Samy I. McFarlane

  2. ASH Comprehensive Hypertension Center, Department of Medicine, University of Chicago Medical Center, 5841 S. Maryland Avenue, MC1027, Chicago, 60637, Illinois, USA

    George L. Bakris

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Buddineni, J.P., Chaudhary, K., Whaley-Connell, A. (2012). Predictors of Kidney Disease in Diabetic, Hypertensive Patients. In: McFarlane, S., Bakris, G. (eds) Diabetes and Hypertension. Contemporary Diabetes. Humana Press, Totowa, NJ. https://doi.org/10.1007/978-1-60327-357-2_9

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