Kidney: its impact on glucose homeostasis and hormonal regulation.
Level 5 - mechanism / opinion, no new human data
Narrative review summarizing physiological mechanisms without systematic search methodology
PubMed 21864754 · doi:10.1016/S0168-8227(11)70016-X
What was done
This narrative review synthesizes evidence from combined isotopic tracer and net balance physiological studies examining the role of the human kidney in glucose homeostasis, renal gluconeogenesis, glucose uptake, tubular reabsorption via SGLT2, and alterations in type 2 diabetes mellitus.
What was found
In the postabsorptive state, the human kidneys and liver release approximately equal amounts of glucose via gluconeogenesis. In the postprandial state, renal gluconeogenesis increases by approximately 2-fold despite an overall reduction in total endogenous glucose release. Normal kidneys filter approximately 180 g of glucose per day, almost all of which is reabsorbed by SGLT2. Renal glucose release is stimulated by epinephrine, inhibited by insulin, and primarily uses lactate, glutamine, and glycerol as precursors. In type 2 diabetes mellitus, renal gluconeogenesis, glucose uptake, and glucose reabsorption are all increased.
Why it matters
This paper clarifies that the kidney is a major gluconeogenic organ comparable to the liver, highlighting its central role in normal glucose regulation and diabetic pathophysiology.
Limits
As a narrative review, no primary patient sample sizes, systematic search criteria, or quantitative variance estimates are provided. Findings reflect mechanistic and tracer balance measurements rather than prospective clinical outcomes.
Cited by
- supports Kidney nephrons perform gluconeogenesis to synthesize glucose for the body.