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Background The unbalanced gut microbiota, poorly ingested enriched fiber foods, leaky gut is connected to the progression of chronic kidney disease (CKD). The leaky gut translocates uremic toxins to the systemic circulation, promote systemic inflammation, worsen CKD. Decreasing the uremic toxins influx from the gut may decrease the progression of CKD. So, we aimed to evaluate the effect of probiotic and symbiotic supplementation on the leaky gut and their role to prevent CKD progression. Methods 48 white albino rats were randomly allocated into 6 groups: sham group; CKD rats; probiotic treated and symbiotic treated rats. Treatment started either immediately or 2 weeks after the operation for each treated group. Blood pressure, body weight changes, serum level of urea, creatinine, indoxyl sulphate and CRP were determined. Histological studies of kidney remnants and intestine and renal fibrosis index were calculated. SPSS program was used for statistics. Results Serum urea, creatinine, indoxyl sulphate, CRP, fibrosis index and blood pressure significantly increased in CKD rats. Probiotic treatment decreased serum level of urea, creatinine and CRP and fibrosis index. Symbiotic treatment decreased the serum level of urea, creatinine, indoxyl sulphate and CRP compared to CKD rats. Blood pressure and fibrosis index were decreased significantly upon symbiotic treatment. Conclusions A strong correlation between the gut microbial ecosystem and CKD has been proved. The use of probiotics and symbiotic to modulate an unhealthy gut microbiome is a promising intervention to delay CKD progression specially in early stages. Symbiotic results were better than probiotic alone.

Background Cholestasis is the obstruction or the reduction in bile flow that results in intrahepatic accumulation of bile constituents, which progresses to develop liver pathology. Common bile duct ligation (BDL) in rodents is an experimental model of cholestasis that has been carried out in research for many years. BDL model of cholestatic liver injury involves other mechanisms, including oxidative stress, inflammation, and fibrogenesis. Antioxidant, antiinflammatory or antiapoptotic properties gained much interest for the amelioration of liver dysfunction. Aim the aim of this study is to assess the possible protective effects of onion supplementation on hepatic structural and functional alterations induced by BDL in rats, which reflect the effects of cholestasis resulting from intrahepatic accumulation of bile. Methods Thirty adult female Wistar rats were randomly and equally allocated into three groups: (1) control group, (2) BDL group; subjected to ligation of the common bile duct and (3) Onion-supplemented BDL groups (O-BDL). Both control and BDL groups received distilled water (solvent for onion powder) daily by gavage for 4 weeks. Onion-supplemented BDL group (O-BDL); subjected to ligation of the common bile duct and then received 500 mg/kg of onion powder dissolved in distilled water, daily by gavage for 4 weeks. At the end of the experimental period, plasma levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), direct bilirubin, total proteins, total antioxidant capacity (TAC), tumor necrosis factor-α (TNF-α), and hepatic tissue level of malondialdehyde (MDA) and transforming growth factor-β (TGF-β) were measured for all groups. In addition, histopathological examination of liver tissue samples was performed for the three groups. Results Plasma levels of ALT, AST, ALP, direct bilirubin, TNF-α and hepatic tissue levels of MDA and TGF-β were significantly increased and TAC was significantly decreased in the BDL group compared to the control group. In addition, altered architecture was detected in hepatic tissue samples of BDL group. Onion supplementation significantly decreased the plasma levels of ALT, AST, ALP, direct bilirubin, TNF-α and hepatic tissue levels of MDA and TGF-β in the O-BDL group when compared to the BDL group. Total proteins level was not significantly different among all the studied groups. In addition in O-BDL group, histopathological examination of liver revealed near normal structure of hepatic tissue. Conclusion BDL induces hepatic structural alterations and functional disturbances. Onion supplementation inhibits inflammation and oxidative insults that associate BDL, and subsequently protects against BDL-induced liver injury.

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Background: Chronic kidney disease (CKD) is characterized by impaired kidney function, progressive kidney damage, unbalanced gut microbiota and disrupted intestinal mucosal barrier function. The damaged intestinal barrier functions mediated mostly by urea, allows influx of toxic products such as indoxyl sulphate that cause systemic inflammation. Activated charcoal is a universal antidote for the majority of poisons. Activated charcoal was suggested as a supplementary treatment for patients with CKD to remove waste products such as urea, indoxyl sulphate and other toxins .Objectives: This study was designed to investigate the possible role of activated charcoal in limiting the influx of intestinal bacterial toxins to systemic circulation to limit progression of CKD in albino rats.Material and Methods: Forty male white albino rats were divided into 4 equal groups. Sham operated control group (Group I): rats in this group were subjected to all steps of 5/6th nephrectomy except for kidney removal and sacrificed after 6 weeks, 5/6th nephrectomised group (Group II): were subjected to 5/6th nephrectomy operation, early charcoal treated 5/6th nephrectomised group (Group III ): were subjected to 5/6th nephrectomy operation and charcoal treatment (4g/kg/day) started immediately after operation for 6 weeks, and late charcoal treated 5/6th nephrectomised group (Group IV): were subjected to 5/6th nephrectomy operation and charcoal treatment started 2 weeks after operation continued for 4 weeks .Body weight and arterial blood pressure were measured before scarification after 6 weeks. Level of creatinine, urea, indoxyl sulphate and C-reactive protein were determined in the serum. Histological studies of pieces of terminal ileum and colon stained hematoxylin and eosin were done. Renal fibrosis index was assessed in remnant kidney stained with Masson Trichome .Results: Group II had elevated serum level of urea, creatinine, indoxyl sulfate and C-reactive protein, colonic erosions and renal fibrosis compared to control group. Group III showed decreased level of serum creatinine, urea, indoxyl sulphate and C-reactive protein with partial restoration of the colonic mucosal integrity and reduction in renal fibrosis. Group IV had altered serum creatinine, urea and C-reactive protein but not serum indoxyl sulphate. Arterial blood pressure elevated in all studied groups compared to control group and was not affected by charcoal administration. Conclusion:Activated charcoal has the ability to limit progression of CKD and the fibrotic changes in the kidney as well as to limit the associated intestinal barrier disruption, and the early therapy was more significant compared to late interference .

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