Exploring a Complex Interplay: Kidney–Gut Axis in Pediatric Chronic Kidney Disease
Abstract
:1. Introduction
2. CKD and Gut Microbiota
2.1. Developmental Origins of Health and Disease and CKD
2.2. Nitric Oxide (NO) Prenatal Deficiency and CKD
- Sodium transporters: renal disease and high blood pressure have been linked to increased expression and activity of sodium transporters, leading to higher sodium reabsorption [44,45]. NO has been shown to inhibit the work of certain sodium transporters [46]. Therefore, it is thought that a deficient NO may fail to balance the impaired sodium transporters in the context of early life insults, ultimately contributing to programmed high blood pressure, as illustrated in Figure 1.
- Epigenetic regulation: Epigenetic mechanisms, such as histone alterations, DNA methylation, and RNAs of a non-coding nature play a role in developmental programming [47]. These mechanisms can influence gene expression patterns and contribute to long-term health outcomes. It is possible that NO signaling may impact epigenetic regulation, thereby influencing programming of hypertension and renal disease.
- Gut microbiota: The diversity of the gut microbiota is influenced by various factors, including genetics, comorbidities, and environmental factors like physical exercise, smoking, and medication use. However, it is undeniable that diet, dietary patterns, and specific components of the diet play a significant role in shaping the composition of the gut microbiota. These components refer to microorganisms that are not broken down, but can instead colonize the colon [48]. Moreover, the composition of the diet and the presence or absence of specific nutrients are crucial factors determining the rate at which these bacteria generate and the metabolic effects of the metabolites they produce [49].
2.3. The Kidney–Gut Axis in CKD
2.4. The Kidney–Gut Axis in Urinary Tract Infections
2.5. The Kidney–Gut Axis in Urinary Lithiasis
2.6. The Kidney–Gut Axis in Kidney Transplantation
2.7. The Kidney–Gut Axis in Other Kidney Diseases
3. Microbiota Modulatory Therapies in CKD Patients
3.1. Diet Intervention in Microbiota Modulation in Pediatric CKD
3.2. Probiotics for Microbiota Modulation in Pediatric CKD
3.3. Prebiotics for Microbiota Modulation in CKD
3.4. Postbiotics for Microbiota Modulation in CKD
3.5. Fecal Microbiota Transplantation for Microbiota Modulation in CKD
3.6. Colon Dialysis for Microbiota Modulation in CKD
4. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
Abbreviations
BC | before Christ |
CKD | chronic kidney disease |
DNA | deoxyribonucleic acid |
DOHaD | Developmental Origins of Health and Disease |
ESKD | end-stage kidney disease |
FMT | fecal microbiota transplantation |
IAA | indole-3-acetic acid |
IgA1 | Imunglobuline a1 |
IGM | infant gut microbiota |
IS | indoxyl sulfate |
LPS | lipopolysaccharides |
NF-κB | nuclear factor kappa b |
NO | nitric oxide |
PCS | p-cresyl sulfate |
p-CS | p-cresyl sulfate |
pro-oxidants | promote oxidation |
RNA | ribonucleic acid |
ROS | reactive oxygen species |
RTRs | renal transplant recipients |
SCFA | short-chain fatty acids |
TH17 | t helper 17 |
TLR4 | Toll-like receptor 4 |
TMAO | trimethylamine n-oxide |
TNF | tumor necrosis factor |
Treg | regulatory t cell |
UTI | urinary tract infection |
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Mocanu, A.; Bogos, R.A.; Lazaruc, T.I.; Trandafir, L.M.; Lupu, V.V.; Ioniuc, I.; Alecsa, M.; Ivanov, A.; Lupu, A.; Starcea, I.M. Exploring a Complex Interplay: Kidney–Gut Axis in Pediatric Chronic Kidney Disease. Nutrients 2023, 15, 3609. https://doi.org/10.3390/nu15163609
Mocanu A, Bogos RA, Lazaruc TI, Trandafir LM, Lupu VV, Ioniuc I, Alecsa M, Ivanov A, Lupu A, Starcea IM. Exploring a Complex Interplay: Kidney–Gut Axis in Pediatric Chronic Kidney Disease. Nutrients. 2023; 15(16):3609. https://doi.org/10.3390/nu15163609
Chicago/Turabian StyleMocanu, Adriana, Roxana Alexandra Bogos, Tudor Ilie Lazaruc, Laura Mihaela Trandafir, Vasile Valeriu Lupu, Ileana Ioniuc, Mirabela Alecsa, Anca Ivanov, Ancuta Lupu, and Iuliana Magdalena Starcea. 2023. "Exploring a Complex Interplay: Kidney–Gut Axis in Pediatric Chronic Kidney Disease" Nutrients 15, no. 16: 3609. https://doi.org/10.3390/nu15163609