Diabetic nephropathy (DN) is a severe complication of diabetes characterized by altered metabolic pathways. Astragaloside IV, a bioactive compound derived from Astragalus membranaceus, has shown potential therapeutic effects in various diseases. This study aims to investigate the protective effects of Astragaloside IV on DN through histomorphological, metabolomic, molecular biological, and gut flora-renal axis approaches. Serum metabolomics analyses were conducted to identify changes in metabolic pathways, focusing on glycerophospholipid metabolism and bile acid metabolism. Additionally, the activation of the AMPK/PI3K/AKT signaling pathway in kidney were examined. The impact of Astragaloside IV on the gut flora-renal axis was assessed by analyzing the relative abundance of specific gut microbiota and their correlations with metabolic parameters. Serum metabolomics analyses revealed significant alterations in glycerophospholipid and bile acid metabolism pathways. Astragaloside IV treatment activated the AMPK/PI3K/AKT signaling pathway, regulate glycolipid metabolism and mitochondrial damage to improve kidney injury. Moreover, Astragaloside IV modulated the relative abundance of gut microbiota, notably increasing Muribaculaceae and Alloprevotella. The relative abundance of Bacteroidota was positively correlated with high-density lipoprotein (HDL) levels and negatively correlated with fasting blood glucose (FBG) and low-density lipoprotein (LDL) levels. Astragaloside IV exerts protective effects against DN by improving the intestinal microenvironment and activating the AMPK/PI3K/AKT signaling pathway in kidney. These findings highlight the therapeutic potential of Astragaloside IV and suggest the efficacy of gut-liver axis mediated therapies for the treatment of DN.
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