*4.1. Human Evidence in Pediatric CKD*

To date, limited data are available to examine whether alterations of gut microbiota by microbiota-targeted therapies can protect against CKD progression and its comorbidities in the pediatric population. For example, *Clostridium butyricum* is a butyrate-producing bacteria used as a probiotic [100]. Oral administration of *Clostridium butyricum* during remission was reported to reduce the frequency of relapse and the need for immunosuppressive agents in children with INS [89]. The protective effect of probiotic therapy was associated with increases in butyrate-producing bacteria and Treg cells. On the other hand, animal studies targeting gut microbiota to prevent the development of CKD and its associated complications have produced some compelling evidence.
