Crosstalk between the nervous system and the kidney

Abstract

Under physiological states, the nervous system and the kidneys communicate with each other to maintain normal body homeostasis. However, pathological states disrupt this interaction as seen in hypertension, and kidney damage can cause impaired renorenal reflex and sodium handling. In acute kidney injury (AKI) and chronic kidney disease (CKD), damaged kidneys can have a detrimental effect on the central nervous system. CKD is an independent risk factor for cerebrovascular disease and cognitive impairment, and many factors, including retention of uremic toxins and phosphate, have been proposed as CKD-specific factors responsible for structural and functional cerebral changes in patients with CKD. However, more studies are needed to determine the precise pathogenesis. Epidemiological studies have shown that AKI is associated with a subsequent risk for developing stroke and dementia. However, recent animal studies have shown that the renal nerve contributes to kidney inflammation and fibrosis, whereas activation of the cholinergic anti-inflammatory pathway, which involves the vagus nerve, the splenic nerve, and immune cells in the spleen, has a significant renoprotective effect. Therefore, elucidating mechanisms of communication between the nervous system and the kidney enables us not only to develop new strategies to ameliorate neurological conditions associated with kidney disease but also to design safe and effective clinical interventions for kidney disease, using the neural and neuroimmune control of kidney injury and disease.

Neurological Complications of Veno-Arterial Extracorporeal Membrane Oxygenation: A Retrospective Case-Control Study

“…A single-center retrospective chart review had found that the mortality rate of patients with combined ECMO and CRRT was higher than that of those receiving ECMO alone (26). A number of studies have indicated that damaged kidneys could have a detrimental effect on the central nervous system in acute kidney injury (AKI), which was also found to be a risk factor for delirium and coma during critical illness (27)(28)(29). In the present study, the proportion of CRRT in the NC group (69.2%) was significantly higher than that in the nNC group (28.6%), and CRRT was one of the independent risk indicators for V-A ECMO patients with neurological complications.…”

Kidney Ischemia/Reperfusion Injury Induces Changes in the Drug Transporter Expression at the Blood–Brain Barrier in vivo and in vitro

“…The authors of the study focused on the hippocampus, but effects on amygdala, insular and cingulate gyrus could be also possible as a background for the functional changes leading specifically to dementia. Moreover, an autonomic imbalance was suggested for the pathophysiology in CKD or AKI ( Tanaka and Okusa, 2020 ), so that an impact of uremic toxin exposure on the autonomic areas of the brain could be associated with this relationship.…”

“…Decreased kidney function in patients with chronic kidney disease (CKD) or acute kidney injury (AKI) often leads to neurological effects such as cognitive impairment, neuropathy and cerebrovascular disease ( Tanaka and Okusa, 2020 ). Blood-borne toxins, normally eliminated by healthy kidneys, are thought to affect brain function through kidney-brain crosstalk ( Lu et al, 2015 ).…”

Cerebrovascular Disease and Cognition in Chronic Kidney Disease Patients

“…The annual incidence of stroke is 15.1% in hemodialysis and 9.6% in CKD patients. In comparison the annual incidence of stroke is 2.6% in patients without CKD (18). Stroke rate in peritoneal dialysis patients is less well-characterized.…”