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Glucose, Insulin, and the Kidney

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Management of Acute Kidney Problems

Abstract

Several types of critical illness are associated with hyperglycemia and insulin resistance. This “diabetes of stress” used to be considered an adaptive response, beneficial for survival. This dogma was challenged by two large randomized clinical trials showing that tight glycemic control with intensive insulin therapy improves morbidity and mortality rates in critically ill patients. Improved morbidity rates associated with intensive insulin therapy included a beneficial effect on kidney function. Possible mechanisms for this renoprotective effect include prevention or attenuation of oxidative and nitrosative stress, protection of the endothelium, and reduction of inflammation, mitochondrial damage, and apoptosis.

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Acknowledgement

Supported by the Fund for Scientific Research (FWO), Flanders, Belgium (G.0533.06 and G.085.09), the Research Council of the Katholieke Universiteit Leuven (GOA2007/14), FWO and KULeuven Research Council Postdoctoral Fellowships to I.V., and FWO Research Assistant Fellowship to J.G. GVdB by the University of Leuven receives structural research financing via the Methusalem program, funded by the Flemish Government.

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Authors and Affiliations

  1. Department of Intensive Care Medicine, University Hospitals, University of Leuven, Herestraat 49, 30000, Leuven, Belgium

    Greet Van den Berghe

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  1. Miet Schetz
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  2. Ilse Vanhorebeek
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  3. Jan Gunst
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  4. Greet Van den Berghe
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Correspondence to Greet Van den Berghe .

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  1. Charité Campus Virchow, Universitätsklinikum Berlin, Augustenburger Platz 1, Berlin, 13353, Germany

    Achim Jörres

  2. Dipto. Nefrologia, Ospedale San Bortolo, Viale Rodolfi 16, Vicenza, 36100, Italy

    Claudio Ronco

  3. School of Medicine, University of Pittsburgh, Terrace Street 3550, Pittsburgh, 15261, U.S.A.

    John A. Kellum

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Schetz, M., Vanhorebeek, I., Gunst, J., Van den Berghe, G. (2010). Glucose, Insulin, and the Kidney. In: Jörres, A., Ronco, C., Kellum, J. (eds) Management of Acute Kidney Problems. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-540-69441-0_19

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