Kidney-gut crosstalk in renal disease
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REVIEW ARTICLE
Kidney-gut crosstalk in renal disease Iara Colombo 1 & Florencia Aiello-Battan 1 & Rosario Elena 1 & Agustina Ruiz 1 & Lucas Petraglia 2 & Carlos G. Musso 1,3,4 Received: 24 May 2020 / Accepted: 12 November 2020 # Royal Academy of Medicine in Ireland 2020
Abstract Introduction The colon has an important role in managing nitrogenous waste products, electrolytes, and mineral balance during kidney diseases. However, colonic microbiota produces uremic toxins, such as indoxyl sulfate and p-cresyl sulfate, in chronic kidney disease (CKD) patients, which due to their proinflammatory properties contribute to CKD progression. Conversely, in acute renal injury patients, intestinal microbiota could reduce inflammation by secreting short-chain fatty acids and inducing a renal protective immune response. However, since the intestines are the most frequently affected organ in advanced sepsis, colonic microbiota can also represent a negative factor for kidney health in this scenario. Conclusion In the present review, the main characteristics of kidney-gut crosstalk are described. Keywords Crosstalk . Gut . Kidney
Introduction The concept of crosstalk or intercommunication among different organs is based on the biosemiotic perspective which sees the organism as a dynamic structure generated and maintained by a continuous flow of information from and to its different layers of biological complexity, such as cells, tissues, organs, and organ systems. From this perspective, the organs are not simply the anatomical structures which generate these intercommunication but also the product of them [1]. In this sense, the kidney-gut crosstalk is one of the most complex forms of organic intercommunication in the economy since it involves not only these organs but also the varied colonic microbiota. Concerning the physiologic relationship between the colon and the kidney, despite the limited colonic effect in normal renal function, its role in managing nitrogenous waste products, electrolytes, and mineral balance becomes important as * Carlos G. Musso [email protected] 1
Human Physiology Department, Instituto Universitario del Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
2
Nephrology Residency, Nephrology Division, Hospital Universitario CEMIC, Buenos Aires, Argentina
3
Facultad de Ciencias de la Salud, Universidad Simon Bolivar, Barranquilla, Colombia
4
Ageing Biology Unit, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
kidney function deteriorates. In this sense, it stands out the participation of the large intestine in potassium balance, since CKD patients characteristically maintain normal serum potassium levels despite their declined renal function. This phenomenon depends on the colon which progressively increases the patient’s potassium fecal excretion. This large intestine adaptation has been documented in animal models where CKD is accompanied by increased colonic potassium secretion, which is stimulated by aldosterone secretion [2–4]. Besides, the colon also con
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