Acute Kidney Injury and Intestinal Dysbiosis

Abstract

Within the multiple communication pathways of the intestine-kidney axis, one of the most important pathways is the interaction between the commensals of the intestinal microbiome, through the production of short-chain fatty acids, and the segments of the nephron. These interactions maintain a perfect environmental balance. During AKI, there are negative repercussions in all organs, and the systemic interconnection is related in part to the intense inflammation and the uremic environment that this syndrome generates. For example, in the intestine, the microbiome is severely affected, with a decrease in benign bacteria that promote anti-inflammatory effects and an increase in negative, pro-inflammatory bacteria. This scenario of intestinal dysbiosis widens the inflammatory loop that favors worsening kidney function and the probability of dying. It is possible that the manipulation of the intestinal microbiome with probiotics, prebiotics and symbiotics is a reasonable therapeutic goal for AKI.

Investigating gut microbiota–blood and urine metabolite correlations in early sepsis-induced acute kidney injury: insights from targeted KEGG analyses

“…Acute kidney injury (AKI) is a common complication of sepsis, and sepsis-associated AKI (SA-AKI) increases the risk of patient mortality (Peng et al, 2014). Existing research suggests that the gut microbiota is involved in the occurrence and progression of SA-AKI (Zhang et al, 2018;Chavez-Iñiguez et al, 2022;Xu et al, 2022). Meijers et al proposed the concept of the "gut-kidney axis" in 2011; subsequently, Pahl et al refined the theory (Meijers and Evenepoel, 2011;Pahl and Vaziri, 2015).…”

“…Acute kidney injury (AKI) is a common complication of sepsis, and sepsis-associated AKI (SA-AKI) increases the risk of patient mortality ( Peng et al., 2014 ). Existing research suggests that the gut microbiota is involved in the occurrence and progression of SA-AKI ( Zhang et al., 2018 ; Chávez-Iñiguez et al., 2022 ; Xu et al., 2022 ). Meijers et al.…”

Probiotics in septic acute kidney injury, a double blind, randomized control trial

“…Since AKI is a syndrome that generates intense systemic inflammation [ 22 ], attenuation of this phenomenon has been shown to improve renal function and parenchymal damage [ 23 , 24 ]. AKI and intestinal dysbiosis coexist, amplifying local and systemic inflammation and facilitating the proliferation of harmful intestinal bacteria, which generates a vicious cycle that worsens clinical status and causes kidney injury and subsequent systemic failure [ 14 , 25 ]. It seems reasonable that modulating the microbiota and improving intestinal dysbiosis during AKI by administrating probiotics could improve outcomes in patients with these syndromes.…”

Probiotics in septic acute kidney injury, a double blind, randomized control trial

“…In the face of disease and in ammation, the intestinal microbiome undergoes changes in its composition, causing the proliferation of pathogenic bacteria, which in turn promotes more local and systemic in ammation, elevated concentrations of uremic toxins, increased intestinal permeability, endotoxemia, and immunode ciency (7,8), affecting homeostasis through different pathways. This phenomenon is called intestinal dysbiosis (6) and has been associated with adverse clinical outcomes in experimental models and humans in many different clinical scenarios, such as the systemic in ammatory response syndrome (9), sepsis (10), chronic kidney disease (CKD) and acute kidney injury (AKI) (11,12,13,14). AKI occurs in one out of every four hospitalized patients, and 22.8% of these cases die during hospitalization (15,16).…”

“…Since AKI is a syndrome that generates intense systemic in ammation (22), attenuation of this phenomenon has been shown to improve renal function and parenchymal damage (23,24). And since AKI and intestinal dysbiosis coexist amplifying local and systemic in ammation, facilitating the proliferation of harmful intestinal bacteria which generates a vicious circle that worsens clinical status, cause kidney injury and subsequent systemic failure, (14,25). It seems reasonable that modulating the microbiota and improving intestinal dysbiosis during AKI by administrating probiotics could improve outcomes in these syndromes.…”