The renal handling of insulin.
The renal handling of insulin.
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肾脏对胰岛素的处理。
DOI：
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发表时间：
1967
影响因子：
15.9
通讯作者：
L. Stimmler
中科院分区：
文献类型：
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作者：
M. Chamberlain;L. Stimmler
通过胰岛素免疫测定法研究了空腹肾功能正常患者的动脉血、肾静脉血和尿液以及正常受试者和肾病患者口服葡萄糖负荷前后的外周静脉血和尿液中胰岛素的肾脏处理。发现肾动静脉胰岛素浓度差异约为29%，表明正常受试者的肾胰岛素清除率显著超过肾小球滤过率。正常人尿中排出的胰岛素从未超过肾小球滤过负荷的1.5%。这与肾小管功能严重受损患者的尿胰岛素清除率接近肾小球滤过率的结果形成对比。这表明，胰岛素通常在肾小球过滤，然后在近端小管几乎完全重吸收或破坏。如果发生重吸收，似乎更有可能，重吸收的胰岛素不会返回肾静脉，并可能与直接从血液中摄取的胰岛素一起用于肾代谢。建议谨慎使用尿胰岛素浓度或排泄作为血清胰岛素水平或胰岛素分泌的指标，因为正常受试者尿液中出现的滤过胰岛素比例非常小且可变，并且尿胰岛素排泄的重大变化可能是由于轻微的肾小管缺陷所致。
The renal handling of insulin was studied by insulin immunoassay in arterial blood, renal venous blood, and urine of fasting patients with normal renal function and in peripheral venous blood and urine of normal subjects and patients with renal disease before and after an oral glucose load. A renal arteriovenous insulin concentration difference of approximately 29% was found and suggests that in normal subjects renal insulin clearance is significantly in excess of glomerular filtration rate. The insulin excreted in the urine of normal individuals at no time exceeded 1.5% of the load filtered at the glomerulus. This contrasts with the finding of a urinary insulin clearance approaching glomerular filtration rate in patients with severely impaired renal tubular function. It is suggested that insulin is normally filtered at the glomerulus and then almost completely reabsorbed or destroyed in the proximal tubule. If reabsorption occurs, as seems more likely, reabsorbed insulin does not return to the renal vein and is presumably utilized in renal metabolism together with insulin taken up directly from the blood. Caution is advised in the use of urinary insulin concentration or excretion as an index of serum insulin level or insulin secretion because a very small and variable proportion of filtered insulin appears in the urine in normal subjects, and major changes in urinary insulin excretion may arise as a result of minor tubular defects.