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Gut–Kidney Connection: Microbiome’s Role in IgA Nephropathy

IgA nephropathy, or Berger disease, is an autoimmune disease that occurs when IgA antibodies are deposited in the kidney. This causes inflammation and damage to the kidneys. However, the complete process of how the disease develops is unclear and the disease currently lacks effective early diagnosis and treatment strategies.

What is IgA? IgA is an antibody that’s part of the immune system and is typically found in the mucous membranes and body fluids. It accounts for about 15% of the total antibodies produced in the body—and remarkably, around three grams of IgA are secreted into the intestines every day.

How are Gut Microbes Involved in IgA Nephropathy?

While the exact development of IgA nephropathy has not been completely deciphered, it’s known that the gut microbiome plays a role. The composition of the gut microbiome can influence aspects of immunity such as stimulating B cells and IgA production in the gut. This relationship goes both ways where the IgA response shapes the gut microbiome as well.

Therapies Targeting the Microbiome-B cell-IgA axis

New therapies have emerged to treat IgA nephropathy that target the microbiome-B cell-IgA axis and include those that are approved or currently undergoing clinical trials. These therapies include those that target hyperactive B cells, deplete B cells, or break down IgA. More precise methods, such as those that modulate the microbiome or more targeted depleting of specific B cells, are still emerging and pose an exciting opportunity for the field. 

Citation

Dang, S., Zhang, X., Zhang, Y., & Zhang, H. (2025). New thoughts on the intestinal microbiome-B cell-IgA axis and therapies in IgA nephropathy. Autoimmunity reviews, 24(8), 103835. https://doi.org/10.1016/j.autrev.2025.103835