| Science-Based Article
Explore the role of gut-kidney axis dysbiosis in kidney diseases. Discover the unexpected connection between kidney stones and gut microbes.
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In the intricate web of human health, there exists a remarkable alliance between the gut and the kidneys.
This partnership, often referred to as the “gut-kidney axis,” is not just a passive interaction; it’s a dynamic interplay that significantly influences our overall well-being.
At the heart of this symbiotic relationship lies an intricate ecosystem of microbes, metabolic pathways, and immune responses.
In this exploration, we embark on a journey through this captivating landscape to unravel the role of gut microbes in shaping kidney wellness and how inflammation can both challenge and protect this vital harmony.
Welcome to “Gut Check: Microbes, Inflammation, and Kidney Wellness” where we delve into the fascinating world of the gut-kidney axis and its profound implications for our health.
The gut-kidney axis reveals a vital connection between your gut and kidneys, influencing your well-being through metabolism and immune pathways.1
Your gut absorbs beneficial microbial products while your kidneys maintain balance by eliminating harmful metabolic by-products.
A poor diet can lead to gut imbalance (dysbiosis), causing the buildup of toxins like p-cresyl and indoxyl sulfates in your gut.2
This disrupts your gut barrier, allowing toxins to enter your kidneys, sparking inflammation.
Simultaneously, your immune system responds to imbalanced gut bacteria, further triggering inflammation.3
These interactions link gut health to conditions like chronic kidney disease, hypertension, and more. 4
Understanding this connection can empower your health journey.
Chronic kidney disease (CKD) is a prevalent condition impacting approximately 10% of the global population, imposing substantial burdens on society, the economy, and healthcare systems.5
CKD is characterized by the gradual loss of kidney function, leading to the accumulation of toxic substances and elevated urea levels in the bloodstream, resulting in a condition known as uremia.6
Untreated CKD can progress to end-stage kidney disease (ESKD), for which effective treatments are currently lacking, leaving patients with limited options such as dialysis and kidney transplantation.7
Recent research has shed light on the gut microbiome (GM) as a key player in the development of CKD, with notable findings:
(1) Changes in GM Composition in CKD Patients
Studies have demonstrated quantitative and qualitative alterations in the GM of CKD patients, including reduced microbial richness, diversity, and uniformity.8
CKD patients exhibit increased levels of certain bacteria such as Lachnospiraceae, Enterobacteriaceae (Enterobacter, Klebsiella, Escherichia), Enterococci, Clostridium perfringens, and specific Ruminococcaceae, along with decreased levels of Prevotellaceae, Bacteroidaceae, Lactobacillus, and Bifidobacterium species.9 10
The most consistent findings involve reduced Lactobacillaceae and Bifidobacteriaceae levels, along with elevated Enterobacteriaceae. 11
In a study by Vaziri et al., it was found that uraemia significantly alters GM composition in end-stage renal disease (ESRD) patients.12
Notably, certain bacterial families like Brachybacterium, Catenibacterium, Enterobacteriaceae, and others were elevated in ESRD patients, while Prevotellaceae and Lactobacillaceae were reduced.
(2) GM Differences in Early-Stage CKD
Hu et al. observed GM composition differences between early-stage CKD patients and healthy individuals, noting reduced GM diversity in CKD patients.13
The presence of Ruminococcus and reduced Roseburia proved to be reliable indicators for distinguishing early-stage CKD patients from healthy controls.
A lower abundance of Roseburia in CKD patients, especially in early stages, suggests its potential as a marker of GM dysbiosis.14
(3) GM and CKD Severity
Studies have shown that the relative abundance of Proteobacteria, particularly the family Enterobacteriaceae and genera Escherichia, gradually increases with CKD severity, hinting at Proteobacteria as a potential microbial diagnostic marker for GM dysbiosis.15 16
Moreover, Roseburia levels tend to diminish as CKD progresses.17
In summary, CKD patients exhibit distinct GM profiles characterized by variations in specific genera and species.
These GM alterations hold promise as valuable indicators in clinical models, facilitating the differentiation between healthy individuals and those with CKD.
These GM alterations hold promise as valuable indicators in clinical models, facilitating the differentiation between healthy individuals and those with CKD.18
Understanding the intricate relationship between CKD and the gut microbiome opens up new avenues for potential interventions and personalized treatments.
HIGHLIGHT
The gut microbiome plays a crucial role in chronic kidney disease (CKD), with alterations in microbial composition serving as potential diagnostic markers for CKD severity and progression.
Kidney stones, a prevalent ailment affecting 10-15% of the global population, pose serious health risks and complications.19
The most common type, calcium oxalate, accounts for 76% of cases.20
Prolonged kidney stone presence can lead to reduced kidney function and an increased risk of cancer.21
Recent research delves into the gut microbiota’s role in kidney stone disease, with a focus on Oxalobacter formigenes, known for oxalate degradation.22
Previously, O. formigenes deficiency was linked to kidney stones, but recent studies yield inconclusive findings.23
Mendelian randomization studies suggest that the gut microbiota’s role in kidney stones isn’t solely dependent on O. formigenes.24
Emerging research highlights the gut-kidney axis in nephrolithiasis.
Key findings regarding the gut microbiota’s involvement in kidney stone disease include:
Altered Gut Microbiota Composition:
Kidney stone patients exhibit different gut microbiota compositions compared to healthy individuals.25 26 27
A meta-analysis showed elevated Bacteroides and Escherichia_Shigella levels and reduced Prevotella_9 in kidney stone patients.
Gut Microbiota’s Role in Formation:
Studies indicate the gut microbiota’s involvement in kidney stone formation.28 29
Analysis of first-onset renal calculi patients revealed distinctions in gut microbiota composition before and after surgery.
Elevated levels of Enterobacteriales, Enterobacteriaceae, Gammaproteobacteria, and Escherichia correlated with kidney stone formation.
Notably, higher Escherichia levels were linked to decreased urea levels, emphasizing the gut microbiota’s significant role in kidney stone development.
These discoveries shed light on novel perspectives for preventing, diagnosing, and treating kidney stones by understanding the gut-kidney connection.
HIGHLIGHT
Recent research uncovers the gut’s significant role in kidney stone disease, altering microbiota composition, and influencing stone formation, offering potential insights into prevention and treatment.
Renal cell carcinoma (RCC), a prevalent cancer, primarily emerges in the renal parenchyma, with the highest incidence in Western nations. 30
Globally, over 400,000 new RCC cases and 170,000 deaths occur annually. 31
The 2016 WHO classification identifies distinct RCC subtypes, such as clear cell RCC (70-80%), papillary RCC (10-15%), and chromophobe RCC (4-5%).32
Surgical resection is the standard treatment for localized RCC, but 30-40% progress to metastasis despite surgery.33
Survival rates vary significantly, with 92% for localized RCC and only 15% for metastatic cases. 34
While the exact role of the gut microbiota (GM) in RCC remains unclear, dysbiosis may contribute to its development and management. Key findings include:
Altered GM Composition:
Studies show significant differences in GM between RCC patients and healthy individuals, with specific microbial taxa like Blautia and Streptococcus associated with RCC.
These taxa may serve as potential biomarkers.
Another study identified variations in 20 species between RCC and control groups, with some, like Desulfovibrionaceae, associated with RCC.35
GM Dysbiosis and RCC Risk:
Dysbiosis linked to kidney stone (KS) formation may increase RCC risk.
Patients with recurrent KS have a higher risk of kidney cancer.36
Additionally, GM composition may predict the effectiveness of immune checkpoint inhibitors in RCC treatment.37
These findings hint at the GM’s significant role in RCC and its potential as an adjunctive treatment avenue, offering hope for improved diagnosis and therapy.
HIGHLIGHT
The gut microbiome’s influence on renal cell carcinoma (RCC) is emerging, with altered microbial composition and its potential as a diagnostic tool and adjunctive therapy for RCC patients
Emerging research reveals the potential of prebiotics, probiotics, and synbiotics in managing chronic kidney disease (CKD) by reducing uraemic toxins and inflammation.38 39
These interventions also enhance colonic epithelial tight junctions, improving conditions like endotoxemia and blood urea nitrogen levels.
Prebiotic supplementation has shown promise in CKD, although human studies are limited.40
A recent review by McFarlane et al. highlighted varying results and low certainty about these agents’ effects.41
While prebiotic studies in CKD are scarce, the absence of clinical trials in kidney stone (KS) and renal cell carcinoma (RCC) patients presents an attractive avenue for exploration.
In a double-blind, randomized trial by Laffin et al., high-amylose maize-resistant starch type 2 (HAM-RS2) reduced systemic inflammation and increased Faecalibacterium in end-stage CKD patients.42
Prebiotic lactulose supplementation in stages 3 and 4 CKD patients led to decreased creatinine levels and increased Bifidobacteria and Lactobacillus counts. 43
In another study by Biruete et al., inulin supplementation during haemodialysis increased Akkermansia abundance.44
β-glucan fiber supplementation in stage 3 to 5 CKD participants reduced uremic toxins and enriched Bacteroides 2.45
However, further rigorous clinical trials are needed to confirm the safety and efficacy of prebiotics in managing kidney diseases and optimize treatment protocols.
GM modulation remains a promising area of ongoing research in the battle against kidney diseases.
HIGHLIGHT
Prebiotics hold the potential to manage kidney diseases by reducing toxins and inflammation. Clinical trials have shown promise in improving gut health, but further research is needed for comprehensive validation.
In this table, we summarize the main dysbiotic events observed in three types of kidney diseases: chronic kidney disease (CKD), kidney stone (KS) disease, and renal cell carcinoma (RCC).
The dysbiotic events discussed in this table provide insights into the potential role of the gut microbiome in the pathogenesis of kidney diseases and may serve as potential targets for therapeutic interventions.
| Kidney Disease | Main Dysbiotic Events |
|---|---|
| Chronic kidney disease (CKD) | – Patients with CDK display increased gut levels of Lachnospiraceae, Enterobacteriaceae, Enterococci, Clostridium perfringes, and certain Ruminococcaceae, and decreased levels of Prevotellaceae, Bacteroidaceae, and in particular, Lactobacillus and Bifdobacterium species – Ruminococcus exhibits strong discriminatory capability in distinguishing early-stage CKD patients from healthy controls – Relative abundance of Proteobacteria increased gradually with the severity of CKD |
| Kidney stone (KS) disease | – Individuals with KS exhibited higher levels of Bacteroides and Escherichia_Shigella and a lower abundance of Prevotella_9 – Bacteroides, Phascolarctobacterium, Faecalibacterium, Flavobacterium, Akkermansia, Lactobacillus, Escherichia coli, Rhodobacter, and Gordonia served as markers for the detection of KS – Involvement of the GM in KS formation |
| Renal cell carcinoma (RCC) | – Significant alterations in the GM distribution between the RCC patients and the healthy controls – Contribution of GM dysbiosis to the formation of kidney stones, subsequently leading to an increased risk of RCC |
The gut-kidney axis refers to the bidirectional communication and interaction between the gut (intestines) and the kidneys. It involves the exchange of metabolic waste products, immune cells, and signaling molecules between these two organs, which can influence each other’s function and health.
No, your gut does not directly affect your kidneys. The gut and kidneys are separate organs with different functions in the body.
The gut microbiome axis refers to the bidirectional communication between the gut microbiome and various systems in the body, including the gastrointestinal tract, the immune system, the central nervous system, and the endocrine system.
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