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Sonali Gupta and Joseph Mattana

The prevalence of diabetes is rapidly increasing and is projected to affect more than 400 million people by 2030 worldwide. Diabetic nephropathy remains the most serious microvascular complication and most frequent cause of end stage renal disease in the United States. There has been a pressing need for newer therapeutic agents to halt this expanding population and to limit the disease’s associated morbidity, mortality, and expense. Newer antidiabetic medications acting via novel pathways are gaining increased acceptance in medical practice and their renal effects have been the subject of much recent study.

Although the sodium glucose cotransporter (SGLT) inhibitor called

Sonali Gupta, Jose Pichardo, and Joseph Mattana

The gut microbiome is believed to have evolved with time and exists in symbiosis with the system in the healthy state because of its synthetic, metabolic, and immune properties. Recent studies have hypothesized that specific microbial metabolites, particularly short-chain fatty acids and D-amino acids (D-AAs), are important contributors to the maintenance of health. Disturbance of this relationship, known as dysbiosis, has been implicated in various diseases.

The emerging literature on the metabolic potential of gut microflora and its integral role in the pathogenesis of inflammatory conditions is attracting increasing interest from the nephrology community in further exploration of the gut–renal