Ketone bodies in renal function and diabetic kidney disease

Diabetes, as a leading cause of chronic kidney disease (CKD) and diabetic kidney disease (DKD), underscores a significant concern, especially due to its association with health decline and mortality. In this context, the roles of ketone bodies, especially beta-hydroxybutyrate are increasingly recognized for their impact in renal physiology and the pathology of DKD. Moving beyond their conventional perception as metabolic by products, ketone bodies have been found to play a crucial role in renal health, particularly under the stresses of diabetic conditions. Serving as alternative energy sources during periods of glucose scarcity, they also function as important signaling molecules. These ketones significantly influence oxidative stress, nutrient-sensing pathways, and mitochondrial function within the kidneys. The adaptability of renal cells to utilize ketone bodies in diabetes highlights a dynamic metabolic interplay, essential for understanding renal health. The exploration of ketone body metabolism modulation, particularly through interventions like SGLT2 inhibitors and ketogenic diets, opens new avenues in managing DKD. Such insights pave the way for rethinking the role of ketone bodies in renal pathology and diabetes, pointing to novel research directions and therapeutic potentials.