Proteinuria, the Podocyte, and Insulin Resistance

Diabetic nephropathy is a chronic progressive disease that affects 20 to 40% of patients with diabetes mellitus. Clinical trials have shown that strict control of hyperglycemia and hypertension can slow the progression of diabetic nephropathy and that insulin resistance correlates with the onset and severity of albuminuria. This correlation has also been found in normotensive persons who do not have diabetes, suggesting that insulin resistance per se may cause albuminuria. On the basis of these observations, Welsh and colleagues1 recently investigated the role of insulin signaling in the kidney and report that podocyte-specific deficiency of insulin receptors leads to a . . .