Tsuji Kenji, Uchida Naruhiko, Nakanoh Hiroyuki, Fukushima Kazuhiko, Haraguchi Soichiro, Kitamura Shinji, Wada Jun
Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikata-cho, Okayama 700-8558, Japan.
Department of Nephrology, Aoe Clinic, Okayama 700-8607, Japan.
Diagnostics (Basel). 2024 Dec 25;15(1):21. doi: 10.3390/diagnostics15010021.
The gut-kidney axis represents the complex interactions between the gut microbiota and kidney, which significantly impact the progression of chronic kidney disease (CKD) and overall patient health. In CKD patients, imbalances in the gut microbiota promote the production of uremic toxins, such as indoxyl sulfate and p-cresyl sulfate, which impair renal function and contribute to systemic inflammation. Mechanisms like endotoxemia, immune activation and oxidative stress worsen renal damage by activating pro-inflammatory and oxidative pathways. Insights into these mechanisms highlight the impact of gut-derived metabolites, bacterial translocation, and immune response changes on kidney health, suggesting new potential approaches for CKD treatment. Clinical applications, such as dietary interventions, prebiotics, probiotics and fecal microbiota transplantation, are promising in adjusting the gut microbiota to alleviate CKD symptoms and slow disease progression. Current research highlights the clinical relevance of the gut-kidney axis, but further study is essential to clarify these mechanisms' diagnostic biomarkers and optimize therapeutic interventions. This review emphasizes the importance of an integrated approach to CKD management, focusing on the gut microbiota as a therapeutic target to limit kidney injury.
肠-肾轴代表了肠道微生物群与肾脏之间的复杂相互作用，这对慢性肾脏病（CKD）的进展和患者整体健康有着重大影响。在CKD患者中，肠道微生物群的失衡会促进尿毒症毒素的产生，如硫酸吲哚酚和对甲酚硫酸盐，这些毒素会损害肾功能并导致全身炎症。内毒素血症、免疫激活和氧化应激等机制通过激活促炎和氧化途径加重肾脏损伤。对这些机制的深入了解突出了肠道衍生代谢产物、细菌易位和免疫反应变化对肾脏健康的影响，为CKD治疗提出了新的潜在方法。饮食干预、益生元、益生菌和粪便微生物群移植等临床应用有望通过调节肠道微生物群来缓解CKD症状并减缓疾病进展。目前的研究突出了肠-肾轴的临床相关性，但进一步研究对于明确这些机制的诊断生物标志物和优化治疗干预至关重要。本综述强调了综合管理CKD方法的重要性，将肠道微生物群作为限制肾脏损伤损伤的治疗靶点。
