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The binding sites for IGF-1 are widely distributed across the kidney, with higher concentrations observed in the inner medulla.1 Importantly, unilateral nephrectomy (uni-Nx) induces an increase in IGF-1 production in contralateral kidney, which promotes compensatory renal hypertrophy.2 Similarly, both the exogenous administration of recombinant growth hormone (GH), a major stimulus for IGF-1 synthesis during development, and uni-Nx compensatory renal hypertrophy by both, exogenous administration of recombinant GH, which is a principal stimulus for IGF-1 synthesis during development, or uni-Nx result in enhanced renal IGF-1 expression, a critical factor in renal hyperplasia.3 The kidney also produces a variety of IGF-1 binding proteins (IGFBPs), which bind and capture free soluble IGF-1, inhibiting its mitogenic effects.4 To date, six closely related high-affinity IGFBPs have been identified, and all are expressed in the kidney

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In the last 20 years, there has been increasing evidence of vitamin B12 deficiency among metformin-treated diabetic patients