Aims/hypothesis. C-peptide, the cleavage product of proinsulin processing exerts physiological effects including stimulation of Na + ,K + -ATPase in erythrocytes and renal proximal tubules. This study was undertaken to assess the physiological effects of connecting peptide on Na + ,K + -ATPase activity in the medullary thick ascending limb of Henle's loop. Methods. Na + ,K + -ATPase activity was measured as the ouabain-sensitive generation of 32 Pi from γ[ 32 P]-ATP and 86 Rb uptake on isolated rat medullary thick ascending limbs. The cell-surface expression of Na + ,K + -ATPase was evaluated by Western blotting of biotinylated proteins, and its phosphorylation amount was measured by autoradiography. The membrane-associated fraction of protein kinase C isoforms was evaluated by Western blotting. Results. Rat connecting peptide concentration-dependently stimulated Na + ,K + -ATPase activity with a threshold at 10 −9 mol/l and a maximal effect at 10 −7 mol/l. C-peptide (10 −7 mol/l) already stimulates Na + ,K + -ATPase activity after 5 min with a plateau from 15 to 60 min. C-peptide (10 −7 mol/l) stimulated Na + ,K + -ATPase activity and 86 Rb uptake to the same extent, but did not alter Na + ,K + -ATPase cell surface expression. The stimulation of Na + ,K + -ATPase activity was associated with an increase in Na + ,K + -ATPase α-subunit phosphorylation and both effects were abolished by a specific protein kinase C inhibitor. Furthermore, connecting peptide induced selective membrane translocation of PKC-α. Conclusion/interpretation. This study provides evidence that in rat medullary thick ascending limb, C-peptide stimulates Na + ,K + -ATPase activity within a physiological concentration range. This effect is due to an increase in Na + ,K + -ATPase turnover rate that is most likely mediated by protein kinase C-α phosphorylation of the Na + ,K + -ATPase α-subunit, suggesting that C-peptide could control Na + reabsorption during non-fasting periods. [Diabetologia (2003) 46:124-131]