A B S T R A C T The renal extraction and excretion of bovine proinsulin, insulin, and C-peptide and the contribution of the kidney to their total metabolic clearance rate (MCR) were studied in the rat. Metabolic clearance rates were measured by the constant infusion technique and plasma and urine concentrations of each polypeptide were determined by radioimmunoassay.The MCR of insulin (16.4±0.4 ml/min) was significantly greater than that of either proinsulin (6.7 ±0.3 ml/min) or C-peptide (4.6±0.2 ml/min). Metabolic clearance rates were independent of plasma levels over a range of steady-state plasma concentrations varying from 1 to 15 ng/ml.In contrast to the differences in their metabolic clearance rates, the renal disposition of the three polypeptides was similar, being characterized by high extraction and very low urinary clearance. The renal arteriovenous difference of proinsulin, insulin, and C-peptide averaged 36, 40, and 44%, respectively, and was linearly related to their arterial concentration between 2 and 25 ng/ml. When glomerular filtration was markedly reduced or stopped by ureteral obstruction, the renal extraction of proinsulin, insulin, and C-peptide was invariably greater than the simultaneously measured extraction of inulin, indicating that these polypeptides are removed from the renal circulation by both glomerular filtration and direct uptake from peritubular capillary blood. The fractional urinary clearance of each polypeptide never exceeded 0.6%, indicating that more than 99% of the amount filtered was sequestered in the kidney.The renal removal of proinsulin and C-peptide from the circulation accounts for 55 and 69% of their metabolic clearance rates, while the renal contribution to the peripheral metabolism of insulin was smaller, averThis work was published in abstract form in 1972 J. Clin. Invest. 51: 49a.Received for publication 18 September 1972 and in revised form 13 December 1972. aging 33%. This difference is due to the fact that insulin, but not the other two polypeptides, is metabolized to a significant extent by the liver. These results define the renal handling of proinsulin, insulin, and Cpeptide in the rat and indicate that in this species the kidney represents a major site for insulin metabolism and is the main organ responsible for the degradation of proinsulin and C-peptide.
INTRODUCTIONDifferential secretion rates of insulin, proinsulin, and C-peptide by pancreatic beta cells have generally been considered to be the major determinant of their plasma concentrations (1-3). However, in vivo and in vitro studies have indicated that the peripheral distribution, metabolism, and degradation of insulin and proinsulin differ, suggesting that these factors may play an important role in determining their blood levels. Thus, the half disappearance time of proinsulin in dogs (4), swine (5), rats (6), and baboons (5) is two-to threefold longer than that of insulin. Experiments with the isolated perfused liver (7,8) have shown a high clearance of insulin compared with the removal...