Figure 1.

Representation of the pivotal role of gut-kidney axis crosstalk with the brain and the pancreas in the pathogenesis of diabetic nephropathy. Hypothetical image of the pathogenesis pathway for diabetic nephropathy (DN). Sympathetic activation is a common feature in disorders of the brain as well as gut and kidneys. The brain is responsible for sympathetic outflow contributing to an increase in blood pressure and pathogenesis of the gut and kidneys. Dysbiosis in the gut results in an imbalance of intestinal homeostasis. Pathological events in the brain, pancreas, adrenal glands, gut and kidneys significantly contribute to the development of hypertension and DN. Note that some critical pathways such as inflammation pathway have been omitted for clarity. Ach: Acetylcholine; ADH: Antidiuretic hormone; ROS: Reactive oxygen species; DM: Diabetes mellitus; DN: Diabetic nephropathy.