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Neuropathologic Findings in Chronic Kidney Disease (CKD)
Harry V Vinters1, Shino D Magaki2, Christopher Kazu Williams2
1Department of Pathology & Laboratory Medicine; Department of Neurology, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California, 90095-1732, United States.
Summary
Neuropathologic autopsy findings in chronic kidney disease (CKD) patients reveal ischemic infarcts are common. Cerebrovascular disease sequelae, particularly arteriolosclerosis, frequently underlie neurologic issues in these complex patients.
Area of Science:
- Neuropathology
- Nephrology
- Cerebrovascular Disease
Background:
- Studying neuropathologic autopsy findings in chronic kidney disease (CKD) or chronic renal failure (CRF) presents challenges due to heterogeneous etiologies, comorbidities, and agonal events.
- Neurologic complications are common in CKD/CRF patients, but their neuropathologic basis requires further elucidation.
Purpose of the Study:
- To investigate the spectrum of neuropathologic abnormalities in autopsy brains from adult patients with CKD/CRF.
- To identify common cerebrovascular changes and their association with neurologic conditions in this population.
Main Methods:
- Analysis of 40 autopsy brains from adult subjects (ages 34-95 years).
- Detailed neuropathologic examination focusing on ischemic infarcts, atherosclerosis, arteriolosclerosis, microaneurysms, and microvascular calcinosis.
Main Results:
- Ischemic infarcts (cystic, lacunar, microinfarcts) were the most frequent finding, present in over half of subjects.
- Arteriolosclerosis (A/S) was observed in 29/40 subjects, often associated with ischemic infarcts.
- Microvascular calcinosis was noted in the basal ganglia and hippocampus; Charcot-Bouchard microaneurysms were found in three cases.
Conclusions:
- Sequelae of cerebrovascular disease, particularly arteriolosclerosis and microvascular changes, are a significant neuropathologic substrate for neurologic disability in CKD/CRF patients.
- Further research into calcium metabolism regulation in brain microvessels is warranted for both human and animal models.
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