BOF: 2.64
A 64-year-old male who is known to have insulin dependent
diabetes mellitus presents with recurrent episodes of hypoglycaemia. This has
necessitated reduction in his daily insulin dosage.
He also has decreased renal function on account of a
combination of diabetic nephropathy and bilateral renal artery stenosis.
In this patient the recurrent hypoglycaemic episodes are
likely to be a consequence of:
a)
Non Alcoholic Fatty Liver Disease resulting in decreased liver glycogen
stores
b)
Autonomic neuropathy resulting in decreased absorption of sugar
c)
Decreased catabolism of insulin by the kidney
d)
Activation of the renin angiotensin system
e)
Decreased insulin resistance
Answer:
c)
The kidney is one of the sites of catabolism of small
molecular weight proteins.
This is done by endocytosis of these proteins in the
brush border of the proximal tubular cells. In renal failure this process is
reduced and the half-life of these proteins is increased resulting in reduced
insulin requirements in these patients.
Other hormones that are metabolised by the kidneys are:
PTH and calcitonin
