gastro-jРоссийский журнал гастроэнтерологии, гепатологии, колопроктологииRussian Journal of Gastroenterology, Hepatology, Coloproctology1382-43762658-6673«Gastro» LLC10.22416/1382-4376-2023-33-3-7-15gastro-j-895Research ArticleОБЗОРЫREVIEWSУремические токсины микробного происхождения: роль в патогенезе коморбидной патологии у пациентов с хронической болезнью почекMicrobial-Derived Uremic Toxins: Role in the Pathogenesis of Comorbidities in Patients with Chronic Kidney Diseasehttps://orcid.org/0000-0002-5893-3191ПятченковМ. О.PyatchenkovM. O.

Пятченков Михаил Олегович — кандидат медицинских наук, старший преподаватель кафедры нефрологии и эфферентной терапии 

194044, г. Санкт-Петербург, ул. Академика Лебедева, 6

Mikhail O. Pyatchenkov — Сand. Sci. (Med.), Senior Lecturer of the Department of Nephrology and Blood Purification

194044, Saint-Petersburg, Academician Lebedev str., 6

pyatchenkovMD@yandex.ruhttps://orcid.org/0000-0002-7915-3792ВласовА. А.VlasovA. A.

Власов Андрей Александрович — кандидат медицинских наук, соискатель 2-й кафедры (терапии усовершенствования врачей) 

194044, г. Санкт-Петербург, ул. Академика Лебедева, 6

Andrey A. Vlasov — Сand. Sci. (Med.), Resident of 2nd Therapy Department of Postgraduate Education

194044, Saint-Petersburg, Academician Lebedev str., 6

vlasovandrej@mail.ruhttps://orcid.org/0000-0002-3045-1721ЩербаковЕ. В.SherbakovE. V.

Щербаков Евгений Вячеславович — врач-нефролог клиники нефрологии и эфферентной терапии 

194044, г. Санкт-Петербург, ул. Академика Лебедева, 6

Evgeniy V. Sherbakov — Nephrologist of the Department of Nephrology and Blood Purification

194044, Saint-Petersburg, Academician Lebedev str., 6

evgenvmeda@mail.ruhttps://orcid.org/0000-0003-4839-9578СаликоваС. П.SalikovaS. P.

Саликова Светлана Петровна — доктор медицинских наук, доцент 2-й кафедры (терапии усовершенствования врачей) 

194044, г. Санкт-Петербург, ул. Академика Лебедева, 6

Svetlana P.  Salikova — Dr. Sci. (Med.), Associate Professor of the 2nd Therapy Department of Postgraduate Education

194044, Saint-Petersburg, Academician Lebedev str., 6

salikova.1966@bk.ruФГБВОУ ВО «Военно-медицинская академия им. С.М. Кирова» Министерства обороны Российской ФедерацииРоссияKirov Military Medical AcademyRussian Federation202311092023333715Copyright © Пятченков М.О., Власов А.А., Щербаков Е.В., Саликова С.П., 20232023Пятченков М.О., Власов А.А., Щербаков Е.В., Саликова С.П.Pyatchenkov M.O., Vlasov A.A., Sherbakov E.V., Salikova S.P.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.gastro-j.ru/jour/article/view/895Цель публикации

Цель публикации. Проанализировать значение уремических токсинов микробного происхождения (УТМП) в патогенезе коморбидной патологии у пациентов с хронической болезнью почек (ХБП).

Основные положения

Основные положения. Повышенная экскреция продуктов азотистого обмена в кишечник при ХБП ассоциирована с уремическим дисбиозом; изменениями метаболической активности микробиоты и синдромом повышенной эпителиальной проницаемости кишечника; которые во многом обусловливают накопление во внутренних средах организма УТМП: индоксил сульфата; р-крезил сульфата; триметиламин-N-оксида и др. Результаты исследований последних лет позволяют рассматривать эти соединения в качестве самостоятельного фактора риска неблагоприятных исходов у лиц с ХБП вследствие прогрессирования дисфункции почек до терминальной стадии; а также частых сердечно-сосудистых; неврологических; минерально-костных; алиментарных и других осложнений.

Выводы

Выводы. УТМП являются одними из ключевых модуляторов перекрестной патогенетической взаимосвязи между кишечником и почками. Воздействие на кишечную микробиоту можно считать перспективной стратегией предупреждения осложнений; связанных с уремией.

Аim

Аim: to analyze the significance of microbial-derived uremic toxins (MDUT) in the pathogenesis of comorbidities in patients with chronic kidney disease (CKD).

Key findings

Key findings. Increased excretion of nitrogen metabolism products into the intestines of patients with CKD is associated with uremic dysbiosis; changes in the metabolic activity of the gut microbiota and the leaky gut syndrome; which largely cause the accumulation of MDUT in the internal environment of the body: indoxyl sulfate; p-cresyl sulfate; trimethylamine-N-oxide; etc. The results of recent studies allow to consider these metabolites as an independent risk factor for adverse outcomes in people with CKD due to the progression of renal dysfunction to the terminal stage; as well as frequent cardiovascular; neurological; bone mineral; nutritional and other complications.

Conclusion

Conclusion. MDUT are one of the key modulators of the pathogenetic relationship between the gut and kidneys. Therapeutic manipulations with intestinal microbiota can be considered a promising strategy for preventing complications associated with uremia.

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The authors declare that there are no conflicts of interest present.