Insulin Resistance, Microalbuminuria, and Chronic Kidney Disease

摘要

Since the early decades of the 20th century, clinicians have described the coexistence in some individuals of certain disorders-type 2 diabetes mellitus, elevated blood pressure, obesity, and dyslipidemia-using several terms to name this "syndrome" . However, only in 1988 did the modern era begin for what we now call the "metabolic" or "insulin resistance" syndrome. That year, Reaven described "syndrome X" and proposed that insulin resistance is the common etiologic factor for a group of disturbances: impaired glucose tolerance, hyperinsulinemia, high levels of very-low-density lipoprotein triglycerides, low levels of high-density lipoprotein cholesterol, and hypertension . In subsequent years, an enormous number of studies investigated the possible epidemiologic and pathophysiologic associations between insulin resistance and other factors to determine which disturbances belonged to the clustering of the metabolic syndrome . These research efforts were coupled from attempts to define this entity, which helped to form a stable reference context for the metabolic syndrome but also met with criticism, mainly regarding the prognostic utility for cardiovascular disease . Today, it seems that the epidemiologic coexistence of the main disorders included in the metabolic syndrome and the central role of insulin resistance in its underlying pathogenesis cannot be denied . Ongoing research is expected to further clarify these associations and help form a consensus definition that can be used as both a diagnostic and prognostic tool.