Insulin and renal sodium handling: Clinical implications

Over the last ten years a large body of information has accumulated which indicates that physiologic changes in the plasma insulin concentration are capable of affecting electrolyte transport by the kidney as well as by a variety of other tissues. In the present discussion the effect of insulin on the renal handling of sodium, potassium, phosphate, and calcium is reviewed, with an emphasis on sodium transport. An attempt is made to relate the effects of insulin on sodium metabolism to four common clinical situations: hypertension and obesity, sodium wasting in diabetes mellitus, natriuresis of starvation, and sodium retention and edema following refeeding.