[The role of hyperinsulinemia and insulin resistance in development of chronic kidney disease in patients with metabolic syndrome].

AIM: To examine relations between hyperinsulinemia, insulin resistance (IR). components of metabolic syndrome (MS) and predisposition to renal damage, MATERIAL AND METHODS: A total of 94 MS patients (64 males and 30 females, age 30-67 years, mean age 52 +/- 9 years) entered the study. The examination included measurement of waist and hip circumference, body mass index (BMI), HOMA index, estimation of lipids and immunoreactive insulin concentrations. Renal damage was assessed by glomerular filtration rate and urinary excretion of albumin. The patients were divided into groups by IR and BMI. RESULTS: A strong correlation was found between IR markers and lipid metabolism disorders, hemodynamic parameters. Statistics show that IR is an independent unfavourable factor of renal damage in MS patients. CONCLUSION: IR is an essential component of MS and an independent factor of development of chronic kidney disease in MS patients.

[The role of lipid metabolism disorders in kidney disease in metabolic syndrome associated with obesity].

AIM: To study the role of lipid metabolism impairment in renal disease in patients with metabolic syndrome associated with obesity. MATERIAL AND METHODS: Lipid metabolism was studied in 77 patients with metabolic syndrome (MS) aged from 17 to 63 years (mean age 48 +/- 9 years). Lipid abnormalities were analysed in groups of patients with different degree of obesity: group 1 - body mass index (BMI) 25-29.9 kg/m2 (n = 13), group 2 - BMI 30-39.9 kg/m2 (n = 49), group 3 - BMI > 40 kg/m2 (n = 15), and in groups of patients with different insulin resistance (IR) : group 1 - HOMA-IR < 2; n = 12; group 2 - HOMA-IR 2 - 4; n = 27; group 3 HOMA-IR > 4; n = 32). Correlation between plasma lipid composition abnormalities and markers of renal disease were studied with correlation analysis. RESULTS: Lipid disbolism in MS patients was characterized with elevated level of triglycerides, total cholesterol (TC), VLDLP cholesterol, low level of HDLP cholesterol. A significant relationship was detected between defective blood lipid composition and renal dysfunction: rise of microalbuminuria, proteinuria, creatinin, inhibition ofglomerular filtration rate. CONCLUSION: The changes found characterize lipid metabolism disorder as an independent factor of kidney disease in patients with MS.

[Contribution of obesity to renal lesions in patients with type 2 diabetes mellitus].

AIM: To study of the contribution of obesity to renal lesion in patients with type 2 diabetes mellitus (T2DM). SUBJECTS AND METHODS: One hundred and fifty-four patients (62 males and 92 females) with T2DM (mean age 58 +/- 8 years) were examined. The study excluded patients with significant stages of diabetic nephropathy (glomerular filtration rate (GFR) < 60 ml/min; proteinuria more than 2 g/day). Anthropometric indicators, such as body mass index (BMI), were estimated. The serum levels of creatinine, uric acid (UA), lipid composition, and the adipose tissue hormones leptin and adiponectin were measured. Renal lesion was evaluated from GFR and urine albumin excretion level. Groups of patients with a less and more than 5-year history and subgroups of a MBI of less and more than 30 kg/mi were identified. RESULTS: In patients with a more than 5-year history of T2DM, the detection rate of microalbuminuria and proteinuria increased as obesity progressed. This regularity was not found in those with a less than 5-year history of T2DM. Diabetic patients with a BMI of > 30 kg/m2 were more frequently found to have intrarenal hemodynamic disorders (hyperfiltration) elevated blood pressure, increased UA, and decreased high-density lipoproteins, as compared with those with a BMI of < 30 kg/m2. With a higher BMI, leptin levels increased; its highest values were found in a group of patients with proteinuria. Hypoadiponectinemia was detected in most patients with T2DM. Adiponectin was decreased in early-stage nephropathy; its increase was further increased. CONCLUSION: There was a greater prevalence of renal lesion in obese (BMI > 30 kg/m2) patients with a more than 5-year history of T2DM than in non-obese patients. Obesity has an impact on renal function due to its hemodynamic, metabolic, and hormonal effects.