The role of intestinal microbiota in the pathogenesis of nephropathy in patients with metabolic syndrome; a systematic review

Talgar Abilov, Gulmira Iztleuova, Sarkyt Kozhantayeva, Zhangeldy Shaimbetov, Yerbolat Maratovich Iztleuov

Journal of Nephropharmacology, 2025

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DOI 10.34172/npj.2025.12795
Data confidence 85 high
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Abstract

Introduction: The gut microbiota plays a vital role in maintaining metabolic and renal health. Dysbiosis associated with metabolic syndrome contributes to the development of nephropathy through mechanisms involving inflammation and the production of uremic toxins. Objectives: This study aims to examine the role of the intestinal microbiota in the onset and progression of nephropathy in patients with metabolic syndrome, particularly its impact on renal function. Methods: A systematic review was conducted covering the period from 2020 to 2025, following PRISMA guidelines. Relevant literature on gut microbiota, nephropathy, and metabolic syndrome was identified through databases including Scopus, Web of Science, Cochrane Library, PubMed, and Europe PMC. The quality of included studies was assessed using the Cochrane Risk of Bias tool and the Newcastle-Ottawa Scale to ensure methodological rigor. Results: The 16 included studies varied in design, study populations, and duration. All reported a reduction in microbial diversity among patients with chronic kidney disease (CKD) and nephropathy. The presence of Prevotella and Faecalibacterium was generally associated with improved kidney function, whereas disease progression correlated with higher levels of Proteobacteria and Clostridium. Metabolites such as indoxyl sulfate and p-cresol glucuronide were commonly linked to nephropathy. Interventions such as probiotic supplementation, fecal microbiota transplantation (FMT), and time-restricted feeding (TRF) showed potential in stabilizing the estimated glomerular filtration rate, reducing uremic toxins, and slowing disease progression. Conclusion: The gut microbiota and its metabolites significantly influence the development and progression of nephropathy in the context of metabolic syndrome. Modulating microbial composition through probiotics and dietary interventions may help restore renal function and mitigate disease advancement. Registration: This review was conducted in accordance with the PRISMA checklist, and the protocol was registered with PROSPERO (ID: CRD420251053100).