IgA nephropathy (IgAN) is a primary glomerular kidney disease associated with mucosal immune dysregulation, which involves the relationship between intestinal immune balance and kidney damage. The gut-kidney axis represents a key concept in the pathogenesis of IgAN, linking gut mucosal immunity to renal pathology. It includes processes such as production of galactose-deficient IgA1, disruption of the intestinal barrier and imbalance of the intestinal microflora. The article proposes precise targeting of this axis as a novel therapeutic strategy for mucosal immunomodulation in IgAN. It includes integrated approaches from microbiome and barrier modulation to specific immune interventions. These multi-target and cross-organ methods offer an alternative to conventional therapies and provide a blueprint for the development of targeted treatments.