Glycolysis and gluconeogenesis in the kidney. A lactate shuttle may operate in the kidney between medulla and cortex as a main source of energy to sustain renal physiology. In diabetic kidneys, HIF may augment the medullary glycolysis rather than oxidative phosphorylation, leading to the production of lactate, which could be taken up by the cortical proximal tubules for gluconeogenesis. Then, renal glucose release in diabetic kidney is increased.
