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Sexual dimorphism shapes renal metabolic adaptation to a ketogenic diet
Journal article   Open access   Peer reviewed

Sexual dimorphism shapes renal metabolic adaptation to a ketogenic diet

Miranda E. Kelly, Lauren A. Hoffner, Cuauhtemoc B. Ramirez, Alexis L. Anica, Joohwan Kim, Gregory Tong, Yeojin Kim, Vyshnavi Mannepalli, Wonsuk Choi, Ki-Hong Jang, …
Cell reports (Cambridge), Vol.45(4), pp.117190-117190
04/28/2026
DOI: 10.1016/j.celrep.2026.117190
PMID: 41904948
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https://doi.org/10.1016/j.celrep.2026.117190View
Published (Version of record) Open Access

Abstract

While kidneys are essential for maintaining systemic metabolic homeostasis and exhibit sexual dimorphism, the effects of sex and environmental factors, such as diet, on renal metabolism remain unclear. Using kidney-specific arteriovenous (AV) metabolomics, in vivo isotope tracing, and transcriptomics, we discover profound sex differences in kidney metabolic reprogramming under ketogenic diet (KD) in C57BL/6J mice. Tissue metabolomics shows the accumulation of aldosterone and acylcarnitines exclusively in female kidneys under a normal chow (NC) diet, suggesting basal sex differences in sodium and fatty acid metabolism. Under KD, AV metabolomics reveals that only female kidneys activate ketogenesis and gluconeogenesis, supported by transcriptional sex differences in related rate-limiting enzymes and transporters. Given the widespread public and clinical interest in KD for treating epilepsy, metabolic disorders, and cancers, our findings underscore the importance of considering sex differences in kidney metabolism as a fundamental variable when interpreting KD’s diverse effects on pathophysiology and therapeutics. [Display omitted] •Kidney metabolomics reveals female-specific aldosterone accumulation•Arteriovenous metabolomics reveals sex differences in kidney metabolic activities•Ketogenic diet induces female-specific renal gluconeogenesis and ketogenesis•Induction of key rate-limiting enzymes mediates gluconeogenesis and ketogenesis By tracking metabolites entering and leaving the kidney in mice, Kelly et al. uncovered strong sex differences in kidney metabolism under normal and ketogenic diets. Female kidneys showed unexpected increases in sugar and ketone production on a ketogenic diet, highlighting sex as an important factor in kidney health and disease.
aldosterone arteriovenous gluconeogenesis ketogenesis ketogenic diet ketone body kidney metabolic flux metabolomics sex difference

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