From intestine to kidney; a narrative literature review

Abstract

Chronic renal failure results to a systemic inflammation and oxidative stress which play a key role in chronic renal failure progression and its unfavorable consequences. Various factors including oxidative stress, metabolic acidosis, decreased clearance of pro-inflammatory cytokines, obesity, infections and dialysis access problems contribute to micro-inflammation in chronic renal failure or hemodialysis. Recently much attention has been directed toward, the possible association between the alterations in gut microbiota composition and intestinal barrier which detected to aggravate inflammation and oxidative stress in chronic renal failure patients. In fact, integrity of the gastrointestinal epithelial cell tight junction that, seals the gap of the epithelial cells is essential to prevent the entrance of antigens, microbial toxins and other harmful luminal contents into the submucosal area and eventually in the body’s internal environment. Inflammation is a continuous aspect and is a main mediator of the progression of chronic renal failure and its several complications, such as cardiovascular complications. Renal failure results in disintegration of the colonic tight junction system, a phenomenon, which can attribute to the systemic inflammation and account for the previously established evidence of defective intestinal barrier function in uremic subjects. Several factors can affect gut microbiota composition such as exercise, smoking, and diet including macronutrient, polyphenol, fiber, vitamins. Thus, life-style interventions that promote healthy diet and physical activity are important strategies to prevent inflammatory diseases, including progression of renal failure. Further studies including randomized controlled trials seem necessary in this field.