December 27, 1971

Insulin and the Kidney

JAMA. 1971;218(13):1937-1938. doi:10.1001/jama.1971.03190260051016

Despite the prominence of the kidney in the pathology of diabetes, its role in insulin metabolism and the role of insulin in renal physiology did not receive the early concentrated attention which was accorded the liver or muscle. This lag was due partly to the traditional view of the kidney as an excretory rather than a metabolic organ and partly to the lack of sensitive investigative techniques. Revolutionary developments in assay methods, as well as recent observations on patients who underwent dialysis and nephrectomy, have stimulated investigations which are clarifying obscure facets of insulin-kidney interrelationships.

In a study by radioimmunoassay, Chamberlain and Stimmler1 found the renal arteriovenous concentration difference of insulin to be approximately 29%. This figure, which is far in excess of what would be expected with glomerular filtration, strongly suggests that most of the filtered insulin is reabsorbed or destroyed in the tubules. Summarizing present knowledge of