Department of Systems Medicine, UOC of Internal Medicine-Center of Hypertension and Nephrology Unit, University of Rome Tor Vergata, Rome, Italy.
Eur Rev Med Pharmacol Sci. 2022 Mar;26(6):2057-2074. doi: 10.26355/eurrev_202203_28354.
During chronic kidney disease (CKD), typical alterations in the gut microbiota are observed. The kidney no longer plays the role of the main excretory organ as this function is performed by the intestine. In CKD patients, an alteration of intestinal permeability and a degradation of the protective mucous layer are observed. These changes in the intestinal barrier allow the passage of bacterial material from the intestine to the bloodstream through the intestinal wall. This phenomenon contributes to the induction of the chronic inflammatory state, typical of CKD. In nephropathic patients, there is an increase in circulation of p-cresyl sulfate (p-CS), indoxyl sulphate (IS), indole-3 acetic acid (IAA) and trimethylamine-N-oxide (TMAO), all gut-derived uremic toxins. The changes in gut microbiota composition are related to CKD stage and this phenomenon is exacerbated in hemodialysis (HD) adult and pediatric patients. Interestingly, it is observed a positive shift in gut microbiota composition after renal transplantation and at the same time a reduction of circulating gut-derived uremic toxins. Either gut dysbiosis or uremic toxins accumulation contribute to the CKD onset and progression.
在慢性肾脏病（CKD）中，观察到肠道微生物群的典型变化。肾脏不再扮演主要排泄器官的角色，因为这个功能由肠道完成。在 CKD 患者中，观察到肠道通透性的改变和保护性粘液层的降解。这些肠道屏障的变化允许细菌物质通过肠壁从肠道进入血液。这种现象导致了 CKD 特有的慢性炎症状态的发生。在肾病患者中，循环中 p- 对甲酚硫酸盐（p-CS）、吲哚硫酸（IS）、吲哚-3-乙酸（IAA）和三甲胺-N-氧化物（TMAO）增加，所有这些都是肠道来源的尿毒症毒素。肠道微生物群组成的变化与 CKD 阶段有关，这种现象在血液透析（HD）成年和儿科患者中更为严重。有趣的是，在肾移植后观察到肠道微生物群组成的积极转变，同时循环中肠道来源的尿毒症毒素减少。肠道菌群失调或尿毒症毒素积累都有助于 CKD 的发生和进展。
