Chronic kidney disease (CKD) affects both brain structure and function. Patients with CKD have a higher risk of both ischemic and hemorrhagic strokes. Age, prior disease history, hypertension, diabetes, atrial fibrillation, smoking, diet, obesity, and sedimentary lifestyle are most common risk factors. Renal-specific pathophysiologic derangements, such as oxidative stress, chronic inflammation, endothelial dysfunction, vascular calcification, anemia, gut dysbiosis, and uremic toxins are important mediators. Dialysis initiation constitutes the highest stroke risk period. CKD significantly worsens stroke outcomes. It is essential to understand the risks and benefits of established stroke therapeutics in patients with CKD, especially in those on dialysis. Subclinical cerebrovascular disease, such as of silent brain infarction, white matter lesions, cerebral microbleeds, and cerebral atrophy are more prevalent with declining renal function. This may lead to functional brain damage manifesting as cognitive impairment. Cognitive dysfunction has been linked to poor compliance with medications, and is associated with greater morbidity and mortality. Thus, understanding the interaction between renal impairment and brain is important in to minimize the risk of neurologic injury in patients with CKD. This article reviews the link between chronic kidney disease and brain abnormalities associated with CKD in detail.
To the Editor:The coronavirus disease , caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has been a major burden on healthcare systems and communities worldwide. It required fast response, transformation of hospitals, and a change of our habits.Many studies have found that chronic kidney disease (CKD) is a risk factor for a more severe course of COVID-19, unfavorable outcomes, with patients receiving dialysis having the highest mortality across all studied factors. [1][2][3] In addition to higher mortality, more adverse outcomes, and severe course of the disease, COVID-19 was more prevalent in patients with CKD receiving dialysis. A cross-sectional study in the United States proved that seroprevalence of SARS-CoV-2 spike protein antibodies was higher in dialysis patients compared to the general public. This demonstrates that patients on dialysis may also be the source of community spread of COVID-19. 4,5 Patients receiving in-center hemodialysis cannot isolate or pause their treatments, resulting in interrupted dialysis schedules or emergent dialysis sessions and even death. 6 With safe vaccination options becoming widely available across the world, there is no doubt that patients with end-stage renal disease (ESRD) should be among the first to be immunized. After extensive discussions, Lithuanian
it possible to determine with high accuracy the threshold values of interstitial fibrosis (>40%) and expression of E-cadherin (<10%) from tubulo-interstitium, in which the achievement of renal response is impossible with a probability close to 80% (Figures 2 and 3). Conclusions: The main characteristic of AKI due to MCN is the rapid (within 2 months) formation of irreversible changes in kidneys: interstitial fibrosis and loss of tubular epithelial phenotype. This is emergency and require intense antimyeloma therapy to achieve hematologic and renal response. The quantitative computer morphometric assessment increases the accuracy of nephropathology studied and can be used in prognostic models.
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