Department of Neurology, UC Irvine School of Medicine, 101 The City Drive South, Shanbrom Hall, Room 121, Orange, CA 92868, United States.
J Stroke Cerebrovasc Dis. 2021 Sep;30(9):105404. doi: 10.1016/j.jstrokecerebrovasdis.2020.105404. Epub 2020 Dec 1.
Numerous studies report linkage between chronic kidney disease (CKD) and cerebrovascular disease. This association has been particularly strong for cerebral small vessel disease. Significant findings have emerged from studies ranging from case reports, small case series, and larger cohort investigations. The latter show a relationship between declining renal function, microvascular disease, and cognitive impairment. One troubling aspect has been the relative paucity of mechanistic investigations addressing the CKD-cerebrovascular disease linkage. Nevertheless, mechanistic observations have begun to emerge, showing cerebral microhemorrhage development in animal models of CKD independent of hypertension, an important co-morbidity in clinical studies. Initial cell culture studies show endothelial monolayer disruption by CKD serum, consistent with blood-brain barrier injury. It is noteworthy that CKD serum is known to contain multiple plausible mediators of microvascular injury. Further studies are on the horizon to address the critical question of potential linkage of renal dysfunction with vascular cognitive impairment.
大量研究报告称慢性肾脏病（CKD）与脑血管病之间存在关联。这种关联在脑小血管病方面尤为明显。从病例报告、小病例系列和更大规模的队列研究中都得出了重要的发现。这些研究表明，肾功能下降、微血管疾病和认知障碍之间存在关联。一个令人困扰的方面是，针对 CKD 与脑血管病之间关联的机制研究相对较少。尽管如此，已经开始出现机制观察结果，表明在 CKD 动物模型中存在与高血压无关的脑微出血发展，高血压是临床研究中的一个重要合并症。初步的细胞培养研究表明，CKD 血清会破坏内皮单层，这与血脑屏障损伤一致。值得注意的是，CKD 血清中已知含有多种可能导致微血管损伤的介质。进一步的研究正在进行中，以解决肾功能障碍与血管性认知障碍之间潜在关联的关键问题。
