Chronic kidney disease and cerebral small vessel disease: a casual or causal cerebrorenal relationship?

Abstract

International Journal of Case Reports and Images (IJCRI) is an international, peer reviewed, monthly, open access, online journal, publishing high-quality, articles in all areas of basic medical sciences and clinical specialties.Aim of IJCRI is to encourage the publication of new information by providing a platform for reporting of unique, unusual and rare cases which enhance understanding of disease process, its diagnosis, management and clinico-pathologic correlations. Chronic kidney disease (CKD) is prevalent in acute stroke patients with rates varying from 20-35% in ischemic stroke and from 20-46% in intracerebral hemorrhage [2,3]. Previously, a higher four to ten times, prevalence of stroke in dialysis patients have been reported [3]. It can therefore be concluded that CKD is an established and emergent risk factor for cardiovascular disease in general and for cerebrovascular disease in particular. IJCRI publishes ReviewChronic kidney disease is defined either by a decrease in the estimated glomerular filtration rate (eGFR) below 60 ml/min/1.73 m 2 or by the presence of albuminuria as a marker of an increased glomerular permeability [4]. It represents also a poor prognosis factor in patients with acute stroke and its presence has been associated with stroke severity and poor outcomes in ischemic and hemorrhagic stroke. A study reported that patients with CKD had a 49% greater risk of neurological deterioration during hospital stay and in-hospital mortality, and higher degree of disability at discharge according to the modified Rankin scale score of 2 or more than patients without CKD [5]. Greater risk of recurrence of non-cardioembolic stroke in CKD patients has also been reported [3]. ThisMarx Rivera-Zambrano 1 , Adrià Arboix 2 , María-JoséSánchez EdiTORiAlS OPEN ACCESSworse neurological prognosis may be caused by the presence in these patients of proteinuria and albuminuria, and both conditions are significantly associated with high levels of inflammatory cytokines and oxidative stress, inflammation and conditions promoting coagulation, potentially causing excessive vascular damage at stroke onset. These factors are also associated with accelerated atherosclerosis and endothelial dysfunction. Albuminuria is also predictive of hemorrhagic transformation of stroke [2]. We must also point out that CKD patients have both high thromboembolic and high bleeding risks and this has implications for deciding the optimal therapeutic strategy for primary or secondary prevention in these clinical conditions. Thus, non-vitamin K antagonist oral anticoagulants (novel oral anticoagulants) seem to be safer and more effective for patients with nonvalvular atrial fibrillation than warfarin, but cannot be given to patients with advanced CKD because the activity of these drugs is greatly affected by renal function [2,6]. Intravenous thrombolysis is not contraindicated for patients with CKD but experts have limited experience with this treatment in these patients [6].It is worth mentioning that kidney impairment is strongly a...