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<p>Kidney diseases, including acute kidney injury (AKI) and chronic kidney disease (CKD), are associated with changes in the composition and function of gut microbiota. Available evidence has delineated that both AKI and CKD were associated with microbial dysbiosis that led to impairment of the intestinal epithelial cell barrier, decreasing the abundance of beneficial bacteria (<i>Lactobacillus reuteri</i> and <i>Bifidobacterium animalis</i>), and increasing the abundance of pathogenic bacteria (<i>Eggerthella lenta</i> and <i>Fusobacterium nucleatum</i>). This was accompanied by the alteration in microbial-derived metabolites, including reducing short-chain fatty acid production and accumulating uremic toxins, such as indoxyl sulphate, indole-3-acetic acid (IAA), and trimethylamine-N-oxide (TMAO), thereby exacerbating renal inflammation and fibrosis. However, supplementation with probiotics, such as <i>Parabacteroides goldsteinii</i>, <i>Lactobacillus johnsonii</i>, <i>Bacteroides ovatus</i> and <i>Bacteroides fragilis</i>, attenuated renal fibrosis by the regulation of nuclear factor κB, NLR family pyrin domain containing 3 inflammasome, aryl hydrocarbon receptor, sodium-glucose transport 2, farnesoid X receptor, glucagon-like peptide-1 receptor, and nuclear factor erythroid 2-related factor 2 signalling pathways via microbial-derived metabolites, such as IAA, TMAO, indole-3-aldehyde, hyodeoxycholic acid and 1,5-anhydroglucitol. This review elaborates on the microbial dysbiosis-related renal pathogenesis and discusses therapeutic potential and targets of renal fibrosis. Further, targeting modulation of gut microbiota by several cardinal approaches, such as probiotics, natural products (neohesperidin, madecassoside, and polysaccharides), and fecal microbiota transplant, are also highlighted. However, these therapeutic approaches need to be further evaluated by large controlled trials. These findings expand the understanding of microbial dysbiosis-associated underlying molecular mechanisms of renal fibrosis in the host and elucidate a clear pathophysiological rationale for the intervention of renal fibrosis.</p>

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Gut microbiota and renal fibrosis: novel mechanistic insights and therapeutic potential

  • 期刊论文

  • 发表日期：

    2026年4月8日

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  • Li-min Liu,
  • Xiao-fei He,
  • Yu-lu Zhang,
  • Jing-teng Zhou,
  • Hua Miao,
  • Ying-yong Zhao

摘要

Kidney diseases, including acute kidney injury (AKI) and chronic kidney disease (CKD), are associated with changes in the composition and function of gut microbiota. Available evidence has delineated that both AKI and CKD were associated with microbial dysbiosis that led to impairment of the intestinal epithelial cell barrier, decreasing the abundance of beneficial bacteria (Lactobacillus reuteri and Bifidobacterium animalis), and increasing the abundance of pathogenic bacteria (Eggerthella lenta and Fusobacterium nucleatum). This was accompanied by the alteration in microbial-derived metabolites, including reducing short-chain fatty acid production and accumulating uremic toxins, such as indoxyl sulphate, indole-3-acetic acid (IAA), and trimethylamine-N-oxide (TMAO), thereby exacerbating renal inflammation and fibrosis. However, supplementation with probiotics, such as Parabacteroides goldsteinii, Lactobacillus johnsonii, Bacteroides ovatus and Bacteroides fragilis, attenuated renal fibrosis by the regulation of nuclear factor κB, NLR family pyrin domain containing 3 inflammasome, aryl hydrocarbon receptor, sodium-glucose transport 2, farnesoid X receptor, glucagon-like peptide-1 receptor, and nuclear factor erythroid 2-related factor 2 signalling pathways via microbial-derived metabolites, such as IAA, TMAO, indole-3-aldehyde, hyodeoxycholic acid and 1,5-anhydroglucitol. This review elaborates on the microbial dysbiosis-related renal pathogenesis and discusses therapeutic potential and targets of renal fibrosis. Further, targeting modulation of gut microbiota by several cardinal approaches, such as probiotics, natural products (neohesperidin, madecassoside, and polysaccharides), and fecal microbiota transplant, are also highlighted. However, these therapeutic approaches need to be further evaluated by large controlled trials. These findings expand the understanding of microbial dysbiosis-associated underlying molecular mechanisms of renal fibrosis in the host and elucidate a clear pathophysiological rationale for the intervention of renal fibrosis.