Precision targeting of gut-kidney axis: mucosal immunomodulation in IgA nephropathy—a perspective

IgA nephropathy (IgAN) is a primary glomerular disease closely linked to mucosal immune dysregulation, involving a complex interplay between intestinal immune homeostasis and renal injury. The “gut-kidney axis” has recently emerged as a central conceptual framework for understanding IgAN pathogenesis, connecting intestinal mucosal immunity with kidney pathology. This perspective article scrutinizes the mechanistic role of this axis, focusing on key processes such as the production of galactose-deficient IgA1, intestinal barrier dysfunction, and gut microbiota dysbiosis. Building on this foundation, we propose “precision targeting of the gut-kidney axis” as a novel therapeutic paradigm for mucosal immunomodulation in IgAN, and discuss integrated strategies ranging from microbial and barrier modulation to specific immune interventions. By emphasizing multi-target, cross-organ approaches, this paradigm offers a promising alternative to conventional therapies and provides a translational roadmap for developing mechanism-based treatments in IgAN.