Kidney-brain axis inflammatory cross-talk: from bench to bedside

• Published in: Clinical science (1979) Vol. 131; no. 11; pp. 1093 - 1105
• Main Authors: Miranda, Aline Silva, Cordeiro, Thiago Macedo, Dos Santos Lacerda Soares, Thomas Mucida, Ferreira, Rodrigo Novaes, Simões E Silva, Ana Cristina
• Format: Journal Article
• Language: English
• Published: England 01.06.2017
• Subjects: Brain - immunology; Cytokines - metabolism; Humans; Inflammation Mediators - metabolism; Kidney - immunology; Neurocognitive Disorders - etiology; Neurocognitive Disorders - immunology; Oxidative Stress - physiology; Renal Insufficiency, Chronic - immunology; Renal Insufficiency, Chronic - psychology; Renin-Angiotensin System - physiology; trophic factors; chronic kidney disease; signaling; inflammation; reactive oxygen species; kidney disease; neuropsychiatric disorders; cytokines; renin–angiotensin system
• ISSN: 0143-5221; 1470-8736
• DOI: 10.1042/cs20160927

Epidemiologic data suggest that individuals at all stages of chronic kidney disease (CKD) have a higher risk of developing neuropsychiatric disorders, cognitive impairment, and dementia. This risk is generally explained by the high prevalence of both symptomatic and subclinical ischemic cerebrovascular lesions. However, other potential mechanisms, including cytokine/chemokine release, production of reactive oxygen species (ROS), circulating and local formation of trophic factors and of renin-angiotensin system (RAS) molecules, could also be involved, especially in the absence of obvious cerebrovascular disease. In this review, we discuss experimental and clinical evidence for the role of these mechanisms in kidney-brain cross-talk. In addition, we hypothesize potential pathways for the interactions between kidney and brain and their pathophysiological role in neuropsychiatric and cognitive changes found in patients with CKD. Understanding the pathophysiologic interactions between renal impairment and brain function is important in order to minimize the risk for future cognitive impairment and to develop new strategies for innovative pharmacological treatment.