Universidad de Buenos Aires, Facultad de Farmacia y Bioquímica, Departamento de Ciencias Biológicas, Cátedra de Anatomía e Histología, Buenos Aires, Argentina.
CONICET - Universidad de Buenos Aires, Instituto de Química y Fisicoquímica Biológicas (IQUIFIB), Buenos Aires, Argentina.
Pflugers Arch. 2020 Mar;472(3):303-320. doi: 10.1007/s00424-020-02352-x. Epub 2020 Feb 17.
Chronic kidney disease (CKD) represents a growing public health problem associated with loss of kidney function and cardiovascular disease (CVD), the main leading cause of morbidity and mortality in CKD. It is well established that CKD is associated with gut dysbiosis. Over the past few years, there has been a growing interest in studying the composition of the gut microbiota in patients with CKD as well as the mechanisms by which gut dysbiosis contributes to CKD progression, in order to identify possible therapeutic targets to improve the morbidity and survival in CKD. The purpose of this review is to explore the clinical evidence and the mechanisms involved in the gut-kidney crosstalk as well as the possible interventions to restore a normal balance of the gut microbiota in CKD. It is well known that the influence of the gut microbiota on the gut-kidney axis acts in a reciprocal way: on the one hand, CKD significantly modifies the composition and functions of the gut microbiota. On the other hand, gut microbiota is able to manipulate the processes leading to CKD onset and progression through inflammatory, endocrine, and neurologic pathways. Understanding the complex interaction between these two organs (gut microbiota and kidney) may provide novel nephroprotective interventions to prevent the progression of CKD by targeting the gut microbiota. The review is divided into three main sections: evidences from clinical studies about the existence of a gut microbiota dysbiosis in CKD; the complex mechanisms that explain the bidirectional relationship between CKD and gut dysbiosis; and reports regarding the effects of prebiotic, probiotic, and synbiotic supplementation to restore gut microbiota balance in CKD.
慢性肾脏病（CKD）是一个日益严重的公共卫生问题，与肾功能丧失和心血管疾病（CVD）有关，CVD 是 CKD 患者发病率和死亡率的主要原因。有充分的证据表明 CKD 与肠道菌群失调有关。在过去的几年中，人们越来越关注研究 CKD 患者肠道微生物组的组成以及肠道菌群失调如何导致 CKD 进展的机制，以便确定可能的治疗靶点来改善 CKD 患者的发病率和生存率。本文旨在探讨肠道-肾脏相互作用的临床证据和相关机制，以及恢复 CKD 患者肠道微生物群正常平衡的可能干预措施。众所周知，肠道微生物群对肠道-肾脏轴的影响是相互的：一方面，CKD 显著改变了肠道微生物群的组成和功能。另一方面，肠道微生物群能够通过炎症、内分泌和神经途径来操纵导致 CKD 发病和进展的过程。了解这两个器官（肠道微生物群和肾脏）之间的复杂相互作用可能为预防 CKD 进展提供新的肾脏保护干预措施，通过靶向肠道微生物群来实现。本文综述分为三个主要部分：CKD 中存在肠道微生物群失调的临床研究证据；解释 CKD 和肠道菌群失调之间双向关系的复杂机制；以及关于益生元、益生菌和合生菌补充剂恢复 CKD 中肠道微生物群平衡的报告。
