Is it hyperinsulinemia or insulin resistance that is related to hypertension and other metabolic cardiovascular risk factors?
Insulin sensitivity was more closely related to blood pressure, serum triglycerides and HDL cholesterol than hyperinsulinemia, but both insulin sensitivity and the insulin levels were associated with fasting glucose. Thus, insulin resistance is more important than hyperinsulinemia as a determinant of the constellation of cardiovascular risk factors comprising hypertension, glucose intolerance and hyperlipidemia.
Tubular cells exposed to albumin present a decrease in both protein and gene expression of Pgp with impairment in transport function. The overexposure of tubular cells to toxic substrates due to Pgp transport failure represents a novel mechanism of tubular damage linked to proteinuria.