Micro-energy acoustic pulse therapy attenuates diabetic nephropathy by restoring renal proliferative capacity and progenitor cell homeostasis independent of glycemic control.

AIMS: Diabetic nephropathy (DN) is characterized by progressive renal dysfunction and impaired intrinsic repair capacity. Micro-energy acoustic pulse (MAP) therapy is a non-invasive mechanical stimulation modality with emerging regenerative potential; however, its effects on diabetic kidney disease remain unclear. This study aimed to investigate whether MAP therapy attenuates DN and to explore its effects on renal cellular dynamics. MAIN METHODS: DN was induced in rats using streptozotocin (STZ). Diabetic animals received weekly bilateral renal MAP treatment for six weeks. Renal function and histopathological changes were evaluated. Renal mitotic activity and resident cell populations were analyzed by flow cytometry using phospho-histone H3 (H3P), CD133, and CD90. KEY FINDINGS: STZ-induced diabetic rats developed persistent hyperglycemia, renal dysfunction, and structural injury. MAP treatment significantly improved renal functional parameters and attenuated glomerular damage without affecting blood glucose levels. Diabetic kidneys exhibited reduced mitotic activity and depletion of CD133+ and CD90+ cell populations, both of which were partially restored following MAP treatment. In addition, MAP shifted these populations toward smaller, regenerative phenotypes. SIGNIFICANCE: MAP therapy attenuated functional and structural features of experimental diabetic nephropathy despite persistent hyperglycemia and was associated with partial restoration of renal mitotic and repair-associated cell populations. These findings support further investigation of low-energy mechanical stimulation as a kidney-directed adjunct to current metabolic therapies, while additional mechanistic, dose-response, and long-term safety studies remain necessary.