The link between Glut-1 and hypertension in diabetic nephropathy

Nephropathy is a major diabetic microvascular complication; both metabolic and hemodynamic perturbations play critical roles in its occurrence and progression toward end-stage renal disease. Improvements in metabolic and blood pressure control have been shown to confer protection from this diabetic complication. In this article, we review the facilitative glucose transporter Glut-1, its regulation, and its potential role in linking metabolic and hemodynamic perturbations in the pathophysiologic processes that lead to kidney injury in diabetes. We propose that an auto-maintaining mechanism of hemodynamic perturbations and increased tissue angiotensin II may be involved in the initiation and maintenance of a loop in which transforming growth factor beta1 and Glut-1 upregulation play important roles in the pathophysiology of diabetic-induced kidney lesions. The understanding of the molecular mechanisms that link glomerular hypertension and excessive glucose metabolism may provide insight into new therapeutic strategies for the treatment of diabetic renal disease.