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Insulin resistance has been linked to microalbuminuria, coronary heart disease and hypertension, as well as now, to the non-modulating, high Na+/Li+ countertransport phenotype. While some of these areas might be easily explained, it is more difficult to rationalise the link between insulin resistance and microalbuminuria as cause and consequence, which raises the question of the common antecedent. Among the possibilities are endothelial dysfunction, low birth weight, and a possible role for pro-inflammatory cytokines.