Nephrin, the key molecule of the glomerular slit diaphragm, is expressed on the surface of podocytes and is critical in preventing albuminuria. In diabetes, hyperglycemia leads to the loss of surface expression of nephrin and causes albuminuria. Here, we report a mechanism that can explain this phenomenon: hyperglycemia directly enhances the rate of nephrin endocytosis via regulation of the -arrestin2-nephrin interaction by PKC␣. We identified PKC␣ and protein interacting with c kinase-1 (PICK1) as nephrin-binding proteins. Hyperglycemia induced up-regulation of PKC␣ and led to the formation of a complex of nephrin, PKC␣, PICK1, and -arrestin2 in vitro and in vivo. Binding of -arrestin2 to the nephrin intracellular domain depended on phosphorylation of nephrin threonine residues 1120 and 1125 by PKC␣. Further, cellular knockdown of PKC␣ and/or PICK1 attenuated the nephrin--arrestin2 interaction and abrogated the amplifying effect of high blood glucose on nephrin endocytosis. In C57BL/6 mice, hyperglycemia over 24 h caused a significant increase in urinary albumin excretion, supporting the concept of the rapid impact of hyperglycemia on glomerular permselectivity. In summary, we have provided a molecular model of hyperglycemia-induced nephrin endocytosis and subsequent proteinuria and highlighted PKC␣ and PICK1 as promising therapeutic targets for diabetic nephropathy.Diabetes mellitus is a major health problem in Western countries. Despite therapeutic advances, diabetic nephropathy remains the leading cause of end stage renal disease (1). Chronic hyperglycemia causes glomerular damages such as endothelial dysfunction, loss of negative charges in the basement membrane, and podocyte damage (2). Microalbuminuria is an early symptom of a "leaky" glomerular barrier and is associated with a markedly increased cardiovascular risk (3).Podocytes are visceral epithelial cells wrapped around glomerular capillaries and are connected by the slit diaphragm. This specialized cell junction is a dynamic multiprotein complex that functions as a size-selective sieve to prevent the loss of plasma proteins through urine (4, 5). Nephrin serves as the backbone of this diaphragm by functioning as a regulator of podocyte signaling and mediator of actin dynamics (6 -8). Several podocyte signaling abnormalities have been noted in diabetes. For example, mice and humans with diabetes show altered distribution and expression of nephrin (9 -11), and hyperglycemia increases diacylglycerol generation, causing PKC activation (2). However, it is not fully understood how "hyperglycemic" signaling in diabetes affects the expression and distribution of nephrin.Menne et al. (12) reported a major step elucidating podocyte signaling in diabetes: they showed that albuminuria does not develop in diabetic PKC␣-deficient mice and concluded that decreased nephrin expression in diabetes is a result of altered transcriptional regulation. All of the studies until now were conducted in chronic models of diabetes (13). Therefore, their conclusions were based...