Inflammation in chronic kidney disease: role in the progression of renal and cardiovascular disease

Abstract

Inflammation is the response of the vasculature or tissues to various stimuli. An acute and chronic proinflammatory state exists in patients with chronic kidney disease (CKD), contributing substantially to morbidity and mortality. There are many mediators of inflammation in adults with CKD and end-stage kidney disease (ESKD), including hypoalbuminemia/malnutrition, atherosclerosis, advanced oxidation protein products, the peroxisome proliferators-activated receptor, leptin, the thiobarbituric acid reactive system, asymmetric dimethyl arginine, iron, fetuin-A, and cytokines. Inflammation contributes to the progression of CKD by inducing the release of cytokines and the increased production and activity of adhesion molecules, which together contribute to T cell adhesion and migration into the interstitium, subsequently attracting pro-fibrotic factors. Inflammation in CKD also causes mortality from cardiovascular disease by contributing to the development of vascular calcifications and endothelial dysfunction. Similar to the situation in adults, cardiovascular disease in pediatric CKD is linked to inflammation: abnormal left ventricular wall geometry is positively associated with markers of inflammation. This review focuses on traditional and novel mediators of inflammation in CKD and ESKD, and the deleterious effect inflammation has on the progression of renal and cardiovascular disease.

Acute Hemolysis After High-Dose Intravenous Immunoglobulin Therapy in Highly HLA Sensitized Patients

“…Therefore, it may be that their enhanced immune reactivity placed them at increased risk of developing hemolysis after IVIG infusions. Furthermore, some individuals with chronic kidney disease have an underlying chronic inflammatory state (22)(23)(24). It is possible that chronic inflammation predisposes this group of patients to IH.…”

SLCO4C1 Transporter Eliminates Uremic Toxins and Attenuates Hypertension and Renal Inflammation

“…In patients with CKD, renal inflammation is also a risk factor of renal damage and morbidity and mortality. 12 Immunohistochemically, mononuclear cell infiltration stained with the macrophage marker CD68 was strongly detected in TG(Ϫ)Nx rat kidneys ( Figure 2C). Conversely, TG(ϩ)Nx kidneys demonstrated less infiltration of macrophage ( Figure 2C).…”

Endothelial Microparticles and Systemic Complement Activation in Patients With Chronic Kidney Disease

“…The increased risk of CVD in this patient population is only partially explained by traditional (Framingham)5, 6 risk factors, and “nontraditional” factors likely influence the risk of CVD 7. Systemic inflammation has been proposed to contribute to the development of CVD in patients with CKD,8 as inflammatory markers, such as C‐reactive protein and interleukin‐6, are elevated in CKD 9, 10, 11, 12. In some observational studies, cytokines prospectively predicted the development of CVD 12…”