الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
The kidney plays an important role in glucose homeostasis and insulin metabolism. Renal gluconeogenesis makes a significant contribution to systemic glucose release in the post-absorptive state of humans. Uremic patients show vulnerability to both hypo- and hyperglycemia. Hyperinsulinemia, glucose intolerance, and dyslipidemia characterizing pre-diabetes mellitus are found in non-diabetic patients with primary kidney diseases even before the onset of impaired renal function and uremia. Insulin resistance is present in patients with mild degrees of renal dysfunction or even in patients with apparently normal renal function i.e., normal creatinine value and low glomerular filtration rate. It is due to retention of nitrogenous compounds and increased mediators secreted by adipose tissues. Anemia, vitamin D deficiency and increased pro-inflammatory state indirectly play a role also. Insulin secretion is also impaired in CRF but its catabolism is significantly decreased. Hemodialysis is capable of improving glucose intolerance may be due to correction of acidosis, improving hyperparathyroidism and by removing circulating diabetogenic toxins. In treatment of diabetes mellitus in presence of renal impairment insulin and short acting oral hypoglycemic agents e.g. glipizide can be used only. Insulin requirement may increase in the beginning of renal failure but in late stages its dose is decreased or even stopped.