A ketogenic diet limits energy supply from glucose and stimulates lipolysis, lipid oxidation, and ketogenesis, resulting in elevated levels of ketone bodies in the bloodstream. Ketone bodies are synthesized in the mitochondrial matrix of liver cells and β-hydroxybutyric acid (BHB) is the most abundant type of ketone body. Herein, we reviewed published findings on the metabolism of ketone bodies and the role of BHB in renal diseases. Through blood circulation, ketone bodies reach metabolically active tissues and provides an alternative source of energy. BHB, being a signaling molecule, mediates various types of cellular signal transduction and participates in the development and progression of many diseases. BHB also has protective and therapeutic effects on a variety of renal diseases. BHB improves the prognosis of renal diseases, such as diabetic kidney disease, chronic kidney disease, acute kidney injury, and polycystic kidney disease, through its antioxidant, anti-inflammatory, and stress response mechanisms. Previous studies have focused on the role of ketone bodies in regulating inflammation and oxidative stress in immune cells. Investigations into the effect of elevated levels of ketone bodies on the metabolism of renal podocytes and tubular cells remain inconclusive. Further research is needed to investigate the effect of BHB on podocyte damage and podocyte senescence in renal diseases.
生酮饮食限制葡萄糖供能，刺激脂肪分解氧化生酮，使循环中酮体水平升高。酮体在肝细胞线粒体基质中产生，β-羟丁酸（beta-hydroxybutyrate, BHB）为酮体的主要成分。本文对酮体的代谢、BHB在肾脏疾病中的功能作用进行综述。酮体通过血液循环分布到代谢活跃的组织作为替代能源供能；BHB作为信号分子，介导多种细胞信号转导，参与多种疾病的发生发展过程。BHB对多种肾脏疾病也具有保护和治疗作用，通过抗氧化、抑制炎症与应激机制改善糖尿病肾病、慢性肾脏病、急性肾损伤、多囊肾病等肾脏疾病的预后。现有的研究聚焦于酮体在免疫细胞中调节炎症、氧化应激反应中的作用，循环中酮体水平升高对肾脏足细胞、肾小管细胞代谢的影响仍未有定论；对肾脏疾病中足细胞损伤、足细胞衰老的作用仍需进一步研究。
Keywords: Anti-inflammatory; Anti-oxidative; Ketone body; Renal disease; Review.
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