Female Protection Against Diabetic Kidney Disease Is Regulated by Kidney-Specific AMPK Activity

Reduced kidney AMPK activity is associated with nutrient stress–induced chronic kidney disease (CKD) in male mice. In contrast, female mice resist nutrient stress–induced CKD. The role of kidney AMPK in sex-related organ protection against nutrient stress and metabolite changes was evaluated in diabetic kidney tubule–specific AMPKg2KO (KTAMPKg2KO) male and female mice. In wild-type (WT) males, diabetes increased albuminuria, urinary kidney injury molecule-1, hypertension, kidney p70S6K phosphory-lation, and kidney matrix accumulation; these features were not exacerbated with KTAMPKg2KO. Whereas WT females had protection against diabetes-induced kidney injury, KTAMPKg2KO led to loss of female protection against kidney disease. The hormone 17b-estradiol ameliorated high glucose–induced AMPK inactivation, p70S6K phos-phorylation, and matrix protein accumulation in kidney tubule cells. The mechanism for female protection against diabetes-induced kidney injury is likely via an estrogen-AMPK pathway, as inhibition of AMPK led to loss of estro-gen protection to glucose-induced mTORC1 activation and matrix production. RNA sequencing and metabolomic analysis identified a decrease in the degradation pathway of phenylalanine and tyrosine resulting in increased urinary phenylalanine and tyrosine levels in females. The metabolite levels correlated with loss of female protection. The findings provide new insights to explain evolutionary ad-vantages to females during states of nutrient challenges.