Podocytes, glucose and insulin

Purpose of review:
In the last decade the importance of the podocyte in maintaining the integrity of the glomerular filtration barrier and prevention of albuminuria has become obvious. The leading cause of renal failure in the developed world is diabetic nephropathy. This has a defined natural history of progressive albuminuria. The two fundamental cellular changes that occur in diabetes mellitus are a failure of insulin to signal to cells and an environment of hyperglycaemia. The emerging role of these factors on the biological function of the podocyte will be reviewed.

Recent findings:
Hyperglycaemia causes both deleterious and protective cellular pathways to be initiated in the podocyte, which communicate with other cell types in the glomerulus. Furthermore, the podocyte is an insulin-sensitive cell which can be directly modulated by factors that increase and decrease its sensitivity to insulin.

Summary:
Our understanding of the cellular processes that affect the podocyte in diabetes and insulin resistance has progressed greatly in recent years and hopefully will result in new treatment strategies against the leading cause of renal failure in the developed world.