Gut–kidney axis: recent advances and clinical applications in pediatric and adult nephrology
DOI:
https://doi.org/10.12873/1089MartinezKeywords:
Gut–kidney axis; Intestinal microbiota; Chronic kidney disease; Pediatrics; Short-chain fatty acidsAbstract
Introduction: The gut–kidney axis represents the bidirectional interaction between intestinal microbiota and renal function. It has been associated with chronic kidney disease (CKD) progression, systemic inflammation, and cardiovascular complications. Objective: To review recent findings (2020–2025) on mechanisms, key metabolites, and therapeutic strategies related to the gut–kidney axis, with a focus on pediatric populations. Material and methods: A systematic search was conducted in PubMed, Scopus, and Web of Science (January 2020–June 2025) using the terms gut-kidney axis, uremic toxins, short-chain fatty acids, and children. Original studies, reviews, and guidelines were included. Results: Intestinal dysbiosis increases uremic toxins (indoxyl sulfate, p-cresyl sulfate, TMAO), associated with inflammation, fibrosis, and poor renal outcomes. Short-chain fatty acids exert protective immunomodulatory effects. In children, elevated indoxyl sulfate correlates with impaired growth. Interventions such as high-fiber diets (KDIGO 2024), probiotics/synbiotics, and intestinal adsorbents (AST-120) show potential benefit. Conclusions: The gut–kidney axis emerges as a key determinant of CKD progression and related complications. Microbiota-derived metabolites constitute biomarkers and potential therapeutic targets. High-quality pediatric clinical trials are warranted.
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