Kamouchi Masahiro
Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University Hospital, Fukuoka, Japan.
Contrib Nephrol. 2013;179:92-9. doi: 10.1159/000346727. Epub 2013 May 3.
Chronic kidney disease (CKD) is an independent risk factor for cardiovascular diseases, including stroke. Patients with CKD are susceptible to ischemic as well as hemorrhagic stroke. The impairments in the small vessel vasculature, atherosclerotic changes of the large vessels, and coagulation abnormalities in CKD probably underlie the specific characteristics of stroke in these patients. The clinical outcomes, including the functional outcomes and short- as well as long-term mortality after stroke, are poor in patients with CKD. CKD is defined as a decreased glomerular filtration rate (GFR) and/or increased urine albumin excretion. A number of studies have shown that either or both of these two markers were significantly associated with poor functional outcomes and mortality after stroke. Recent studies have suggested that proteinuria/albuminuria is more deeply involved in the clinical outcomes than GFR. Although the mechanisms responsible for their association are currently unclear, glomerular barrier and/or filtration dysfunction are probably related to the small vessel diseases, hypercoagulability and inflammation, which may affect the clinical outcomes in CKD patients after stroke. The evidence for the most effective management of acute stroke in CKD patients is lacking, and thus, the current treatment for stroke is optimized for individual patients based on their background. Further studies are thus needed to elucidate the specific features of stroke and also the management of stroke in patients with CKD.
慢性肾脏病（CKD）是包括中风在内的心血管疾病的独立危险因素。CKD患者易发生缺血性和出血性中风。CKD患者的小血管脉管系统损伤、大血管动脉粥样硬化改变以及凝血异常可能是这些患者中风的特定特征的基础。CKD患者中风后的临床结局，包括功能结局以及短期和长期死亡率都很差。CKD的定义为肾小球滤过率（GFR）降低和/或尿白蛋白排泄增加。多项研究表明，这两种标志物中的一种或两种都与中风后的不良功能结局和死亡率显著相关。最近的研究表明，蛋白尿/白蛋白尿比GFR更深入地参与临床结局。尽管目前尚不清楚它们之间关联的机制，但肾小球屏障和/或滤过功能障碍可能与小血管疾病、高凝状态和炎症有关，这可能会影响CKD患者中风后的临床结局。目前缺乏针对CKD患者急性中风最有效管理的证据，因此，目前的中风治疗是根据患者个体背景进行优化的。因此，需要进一步研究以阐明中风的具体特征以及CKD患者中风的管理。
