Get access

Uremia and chronic kidney disease: The role of the gut microflora and therapies with pro- and prebiotics

Authors

  • Luis Vitetta,

    1. Centre for Integrative Clinical and Molecular Medicine, School of Medicine at Princess Alexandra Hospital, The University of Queensland, Brisbane, Australia
    Search for more papers by this author
  • Glenda Gobe

    Corresponding author
    • Centre for Kidney Disease Research, School of Medicine at Princess Alexandra Hospital, The University of Queensland, Brisbane, Australia
    Search for more papers by this author

Correspondence: Associate Professor Glenda Gobe, Centre for Kidney Disease Research, Building 33, School of Medicine, Princess Alexandra Hospital, The University of Queensland, Ipswich Road, Woolloongabba, Brisbane 4102, Australia

E-mail: g.gobe@uq.edu.au

Fax: +61-7-3176-2970

Abstract

Uremia is an illness that accompanies kidney failure and chronic kidney disease (CKD). Uremic illness is considered to be due largely to the accumulation of organic waste products that are normally cleared by the kidneys. However, uremic retention solutes are generated in part in the gastrointestinal tract (GIT), with the gut microbiota and the ensuing micro-biometabolome playing a significant role in the proliferation of uremic retention solutes. Toxins generated in, or introduced into the body via the intestine, such as advanced glycation end products, phenols, and indoles, all may contribute to the pathogenesis of CKD. Hence, it is biologically plausible, but not well recognized, that an important participant in the toxic load that contributes to CKD originates in the GIT. The microbiota that colonize the GIT perform a number of functions that include regulating the normal development and function of the mucosal barriers; assisting with maturation of immunological tissues, which in turn promotes immunological tolerance to antigens from foods, the environment, or potentially pathogenic organisms; controlling nutrient uptake and metabolism; and preventing propagation of pathogenic micro-organisms. Here, we develop a hypothesis that probiotics and prebiotics have a therapeutic role in maintaining a metabolically balanced GIT, and reducing progression of CKD and associated uremia.

Ancillary