Microbiota and kidney disease: the road ahead

Patricia P. Bloom, Division of Gastroenterology, Department of Medicine, University of Michigan, Ann Arbor, MI, USA. ppbloom@med.umich.edu.
Wendy S. Garrett, Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
Kristina L. Penniston, University of Wisconsin School of Medicine and Public Health, Department of Urology, Madison, WI, USA.
Mari-Karoliina H. Winkler, School of Engineering, Civil and Environmental Engineering, University of Washington, Seattle, WA, USA.
Stanley L. Hazen, Center for Microbiome and Human Health, Department of Cardiovascular and Metabolic Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA.
Jose Agudelo, Center for Microbiome and Human Health, Department of Cardiovascular and Metabolic Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA.
Mangesh Suryavanshi, Center for Microbiome and Human Health, Department of Cardiovascular and Metabolic Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA.
Ahmed Babiker, Division of Infectious Diseases, Department of Internal Medicine, Rush University Medical Center, Chicago, IL, USA.
Dylan Dodd, Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA.
Michael A. Fischbach, Department of Bioengineering and ChEM-H, Stanford University, Stanford, CA, USA.
Kerwyn Casey Huang, Department of Microbiology and Immunology, Stanford University School of Medicine, Stanford, CA, USA.
Curtis Huttenhower, Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
Bina Joe, Department of Physiology and Pharmacology, Center for Hypertension and Precision Medicine, Microbiome Consortium, University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA.
Kamyar Kalantar-Zadeh, Division of Nephrology, Hypertension and Transplantation, The Lundquist Institute for Biomedical Innovation at Harbour UCLA Medical Center, Torrance, CA, USA.
Rob Knight, Center for Microbiome innovation, University of California San Diego, La Jolla, CA, USA.
Aaron W. Miller, Center for Microbiome and Human Health, Department of Cardiovascular and Metabolic Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA.
Hamid Rabb, Division of Nephrology, Department of Medicine, Johns Hopkins University, Baltimore, MD, USA.
Anvesha Srivastava, Division of Renal Diseases and Hypertension, Department of Medicine, George Washington University School of Medicine, Washington, DC, USA.
W H. Tang, Center for Microbiome and Human Health, Department of Cardiovascular and Metabolic Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA.
Peter J. Turnbaugh, Chan Zuckerberg Biohub-San Francisco, San Francisco, CA, USA.
Alan W. Walker, Microbiome, Food Innovation and Food Security Theme, Rowett Institute, University of Aberdeen, Aberdeen, UK.
Nicola Wilck, Department of Nephrology and Internal Intensive Care Medicine, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.
Jiaojiao Xu, Department of Physiology, Johns Hopkins School of Medicine, Baltimore, MD, USA.
Tao Yang, Department of Physiology and Pharmacology, Center for Hypertension and Precision Medicine, Microbiome Consortium, University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA.
Jonathan Himmelfarb, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Matthew R. Redinbo, Department of Chemistry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
Gary D. Wu, Division of Gastroenterology and Hepatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
Michael H. Woodworth, Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA, USA.
A Lenore Ackerman, Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
Sebastian Winter, Department of Internal Medicine, Division of Infectious Diseases, UC Davis, Davis, CA, USA.
Markus M. Rinschen, Department of Biomedicine, Aarhus University, Aarhus, Denmark.
Hatim A. Hassan, Division of Nephrology & Hypertension, Mayo Clinic, Rochester, MN, USA.

Document Type

Journal Article

Publication Date

7-28-2025

Journal

Nature reviews. Nephrology

DOI

10.1038/s41581-025-00988-5

Abstract

More than 850 million individuals worldwide, accounting for 10-15% of the adult population, are estimated to have chronic kidney disease. Each of these individuals is host to tens of trillions of microorganisms that are collectively referred to as microbiota - a dynamic ecosystem that both influences host health and is itself influenced by changes in the host. Available evidence supports the existence of functional connections between resident microorganisms and kidney health that are altered in the context of specific kidney diseases, including acute kidney injury, chronic kidney disease and renal stone disease. Moreover, promising data from preclinical studies suggest that targeting of gut microbial pathways may provide new therapeutic opportunities for the treatment of kidney disease. This Roadmap describes current understanding of the mechanisms by which microorganisms regulate host organ function, the effects of kidney disease on the gut microbiome, and how these insights may contribute to the development of microbe-targeted therapeutics. We highlight key knowledge gaps that remain to be addressed and strategies for addressing these, outlining both the promise and the potential pitfalls of leveraging our understanding of the gut microbiota to better understand and treat kidney disease.

Department

Medicine

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