The cross-talk between the kidney and the gut: implications for chronic kidney disease

Abstract

In recent decades, special attention has been given to the potential association between the gut ecosystem and chronic diseases. Several features and complications of chronic kidney disease (CKD) may induce an unbalanced gut environment, leading to unfavorable consequences for a patient's health. The first section of this review is dedicated to a description of some aspects of gut microbiota and intestinal barrier physiology. The following section explores the impact of CKD on the gut ecosystem and intestinal barrier, particularly the association with uremic toxins, inflammation, and immunodeficiency. Finally, the review describes the state of the art of potential therapies with prebiotics, probiotics, and synbiotics employed to modulate the gut environment and to reduce the generation of colon-derived uremic toxins in CKD.

Pathophysiological Mechanisms by which Heat Stress Potentially Induces Kidney Inflammation and Chronic Kidney Disease in Sugarcane Workers

“…(B) Gut–kidney crosstalk with decreased kidney function increasing gut permeability has been hypothesized to fuel systemic inflammation and thereby progressive renal damage both as a cause of CKD progression [ 56 , 57 ] and AKI in septic shock [ 58 ]; and…”

The intricate relationship between gut and kidney

“…In addition, Andrade et al . did not observe a significant difference in the production of reactive oxygen species (ROS) and expression of toll-like receptors (TLR), proteins that recognize bacterial components and are important for gut homeostasis7.…”

“…However, these pathological processes have not yet been fully elucidated. The dysfunction of the intestinal epithelium can be explained, at least in part, by the effects induced by uremia resulting from CKD on intestinal epithelial cells, such as enterocytes and colonocytes1 - 7.…”

“…In addition, clinical studies have shown that the composition of the microbiota is altered in patients with CKD, with a greater abundance of groups capable of producing uremic toxins. Thus, in recent years, several studies with therapeutic focus have been developed in order to modulate the gut microbiota of patients through prebiotics, postbiotics, and symbiotics, but are still inconclusive and further investigation is necessary4 , 7.…”

Current Perspectives and Mechanisms of Relationship between Intestinal Microbiota Dysfunction and Dementia: A Review

“…2 ). Toxic metabolites such as trimethylamine N-oxide, D-amino acids, hippurate, phenylacetylglutamine, polyamines including putrescine, cadaverine, agmatine, and tyramine, acrolein, p -cresol sulfate, indoxyl sulfate, indole-3 acetic, phenol- and sulfur-containing compounds, as well as ammonia produced by the intestinal microbes can destroy the junctional complexes of the intestinal epithelial lining, thereby increasing the leakiness of the gut [, 151 , 152 , 153 , 154 , 155 , 156 , 157 , 158 , 159 , 160 , 161 , 162 , 163 , 164 , 165 ] (immune responses triggered by these microbial metabolites are integral to leaky gut [ 163 , 164 , 165 ]). This increases impairment in selective transport and paracellular shunt of substances between the gut and circulatory system, allowing for unregulated movement of biomolecules including toxins into the surrounding tissues and circulatory system from the luminal side of the gut (Fig.…”