Insulin sensitivity of the human glomerular podocyte: Its biological importance and the role of nephrin in this process.

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The leading cause of kidney failure in the world is secondary to diabetes mellitus (DM). In DM there is either a lack of the production, or cellular action, of insulin. The first sign of kidney involvement in DM is the appearance of small amounts of protein in the urine which increases as the kidneys fail. The glomerular filtration barrier (GFB) is the part of the kidney that acts as a sieve and prevents protein leaking into the urine from the blood. It is made up of two different cell types called podocytes and endothelial cells. We have developed a unique way of studying these cells in the laboratory by culturing them in dishes. Using these cells we have discovered that podocytes are rapidly insulin sensitive, suggesting that insulin sensitivity of the GFB is important in health. Our research intends to study the precise mechanism that insulin exerts its actions on the GFB. We hope that by understanding the insulin responsiveness of the GFB that we may be able to develop new treatments that will treat and prevent urinary protein loss early in disease and ultimately prevent kidney failure in the setting of diabetes.