IgA nephropathy is the most common glomerulonephritis worldwide and is one of the leading causes of end⁃stage kidney disease. It is currently believed that the pathogenesis of IgA nephropathy is the deposition of immune complexes containing galactose⁃deficient IgA1 in mesangium, leading to glomerular injury. Current treatment of IgA nephropathy contains supportive therapy and immunosuppressive therapy. More and more studies have indicated that there is intestinal flora imbalance in individuals with IgA nephropathy, and gut⁃kidney axis may be involved in the occurrence and development of IgA nephropathy. Intestinal flora may participate in the occurrence and development of IgA nephropathy through three main mechanisms, namely, disruption of intestinal barrier, changes in metabolites, and abnormal mucosal immune response. IgA nephropathy can be improved by the therapy of modulating intestinal flora, such as fecal microbiota transplantation, antibiotic therapy, probiotic therapy, Traditional Chinese Medicine therapy, hydroxychloroquine therapy, and gluten⁃free diet. This paper reviews the changes of intestinal flora in individuals with IgA nephropathy, the potential pathogenic mechanism of intestinal flora in IgA nephropathy, and the possible methods of treating IgA nephropathy by regulating intestinal flora, etc.

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