Diabetes, Vol 48, Issue 5 943-948, Copyright © 1999 by American Diabetes Association

ARTICLES

Role of the human kidney in glucose counterregulation

C Meyer, JM Dostou and JE Gerich
Department of Medicine, University of Rochester School of Medicine, New York 14642, USA.

Animal experiments indicate that the kidney may play an important role in glucose counterregulation. Because the human kidney normally takes up and releases glucose, and since patients with end-stage renal disease are prone to hypoglycemia, we examined whether the kidney is also involved in human glucose counterregulation. Accordingly, we compared renal glucose release (RGR) and uptake (RGU) during 4-h hyperinsulinemic-hypoglycemic (approximately 3.2 mmol/l, n = 9) and -euglycemic (approximately 5 mmol/l, n = 10) control clamp experiments in normal postabsorptive subjects. A combination of renal balance and isotopic ([3H]glucose, [14C]glutamine) techniques was used, which permitted hepatic glucose release (HGR) and glutamine gluconeogenesis to be calculated as the difference between systemic (overall) and renal values. In both experiments, infusion of insulin increased plasma insulin comparably (approximately 210 pmol/l). In euglycemic control experiments, RGR and HGR decreased more than 50% (both P<0.001) and RGU increased approximately 35% (P = 0.02). In hypoglycemic experiments, both HGR (P = 0.034) and RGR (P<0.001) increased to a comparable extent (1.69+/-0.47 and 1.67+/-0.15 pmol x kg-(-1) x min(-1), respectively, P = 0.96) above rates observed in control experiments; hepatic and renal glutamine gluconeogenesis increased by 0.19+/-0.06 (P<0.008) and 0.30+/-0.07 pmol x kg(-1) x min(-1) (P< 0.001), respectively. RGU decreased by 65% compared with control experiments (P<0.001), so that renal glucose balance changed from a net uptake of 80+/-19 micromol/min to a net release of 130+/-9 micromol/min, P< 0.001. These observations provide evidence that the kidney may play an important role in human glucose counterregulation.
CiteULike    Del.icio.us    Digg    Reddit    Technorati    What's this?

This article has been cited by other articles:

				R. L. Mehta Glycemic Control and Critical Illness: Is the Kidney Involved? J. Am. Soc. Nephrol., October 1, 2007; 18(10): 2623 - 2627. [Abstract] [Full Text] [PDF]

				D. N. Reeds, W. T. Cade, B. W. Patterson, W. G. Powderly, S. Klein, and K. E. Yarasheski Whole-Body Proteolysis Rate Is Elevated in HIV-Associated Insulin Resistance. Diabetes, October 1, 2006; 55(10): 2849 - 2855. [Abstract] [Full Text] [PDF]

				A. Eid, S. Bodin, B. Ferrier, H. Delage, M. Boghossian, M. Martin, G. Baverel, and A. Conjard Intrinsic Gluconeogenesis Is Enhanced in Renal Proximal Tubules of Zucker Diabetic Fatty Rats J. Am. Soc. Nephrol., February 1, 2006; 17(2): 398 - 405. [Abstract] [Full Text] [PDF]

				C. Meyer, P. Saar, N. Soydan, M. Eckhard, R. G. Bretzel, J. Gerich, and T. Linn A Potential Important Role of Skeletal Muscle in Human Counterregulation of Hypoglycemia J. Clin. Endocrinol. Metab., November 1, 2005; 90(11): 6244 - 6250. [Abstract] [Full Text] [PDF]

				C. Meyer, M. Stumvoll, S. Welle, H. J. Woerle, M. Haymond, and J. Gerich Relative importance of liver, kidney, and substrates in epinephrine-induced increased gluconeogenesis in humans Am J Physiol Endocrinol Metab, October 1, 2003; 285(4): E819 - E826. [Abstract] [Full Text] [PDF]

				H. J. Woerle, C. Meyer, E. M. Popa, P. E. Cryer, and J. E. Gerich Renal Compensation for Impaired Hepatic Glucose Release During Hypoglycemia in Type 2 Diabetes: Further Evidence for Hepatorenal Reciprocity Diabetes, June 1, 2003; 52(6): 1386 - 1392. [Abstract] [Full Text] [PDF]

				C. Meyer, J. M. Dostou, S. L. Welle, and J. E. Gerich Role of human liver, kidney, and skeletal muscle in postprandial glucose homeostasis Am J Physiol Endocrinol Metab, February 1, 2002; 282(2): E419 - E427. [Abstract] [Full Text] [PDF]

				E. Cersosimo, P. Garlick, and J. Ferretti Abnormal Glucose Handling by the Kidney in Response to Hypoglycemia in Type 1 Diabetes Diabetes, September 1, 2001; 50(9): 2087 - 2093. [Abstract] [Full Text] [PDF]

				J. E. Gerich Measurements of Renal Glucose Release Diabetes, April 1, 2001; 50(4): 905 - 905. [Full Text]

				J. E. Gerich, C. Meyer, H. J. Woerle, and M. Stumvoll Renal Gluconeogenesis: Its importance in human glucose homeostasis Diabetes Care, February 1, 2001; 24(2): 382 - 391. [Abstract] [Full Text]

				C. Meyer, M. Stumvoll, J. Dostou, S. Welle, M. Haymond, and J. Gerich Renal substrate exchange and gluconeogenesis in normal postabsorptive humans Am J Physiol Endocrinol Metab, February 1, 2002; 282(2): E428 - E434. [Abstract] [Full Text] [PDF]