Chronic kidney disease [Neurosurgery Wiki]

This page is read only. You can view the source, but not change it. Ask your administrator if you think this is wrong.
====== Chronic kidney disease ======

===== In neurosurgery =====

{{rss>https://pubmed.ncbi.nlm.nih.gov/rss/search/1-KHXJhm35hgwQ1kXJpkVyskXnExDJj_wG2hJelNcxtg7B2ke5/?limit=15&utm_campaign=pubmed-2&fc=20240119134745}}
----

Traumatic brain injury (TBI) is a highly prevalent neurological disorder that affects a gradually increasing proportion of older adults. Chronic kidney disease (CKD) significantly contributes to global years of life lost, with an estimated one-tenth of the global population affected by CKD.  TBI patients comorbid with CKD have a poorer prognosis than those with normal kidney function
((Mo H, Fan F, Liu J, Zhang W, Wang Q, Yuan X. Chronic kidney disease as a predictive factor for poor prognosis in traumatic brain injury among older adults: a case-control study. Front Neurol. 2023 Nov 30;14:1286592. doi: 10.3389/fneur.2023.1286592. PMID: 38099070; PMCID: PMC10720628.)).
----

The diagnosis of [[Cushing's disease]] (CD) is particularly challenging in patients with chronic kidney disease (CKD), due to abnormalities of the hypothalamo-pituitary-adrenal axis associated with the latter. 

A case report presented discrepant biochemical findings in a patient with CKD who was subsequently diagnosed with CD, and outlines principles which may guide the definitive diagnosis of CD in this context.

The case of a patient with Stage 4 CKD who underwent [[transsphenoidal]] surgery for pituitary-dependent CD is presented. A literature review was conducted to identify similar cases and characterise features of hypothalamo-pituitary-adrenal axis dysfunction in CKD.

The patient discussed herein presented with markedly elevated plasma adrenocorticotrophic hormone ([[ACTH]]) due to a [[pituitary macroadenoma]], with normal 24-hour [[urinary free cortisol]] (24-UFC) but abnormal overnight [[dexamethasone suppression test]]ing and elevated [[midnight salivary cortisol]]. He experienced biochemical remission after undergoing transsphenoidal adenomectomy. A literature review revealed that CKD can be associated with elevated serum cortisol, reduced UFC and elevated plasma ACTH. Only four other cases of CD being diagnosed in a patient with CKD have been published. The loss of a circadian rhythm of cortisol secretion was the most common feature amongst all cases.

To establish a definitive [[Pituitary corticotroph adenoma diagnosis]] in the context of pre-existing [[chronic kidney disease]], the absence of circadian rhythms of [[cortisol]] and [[ACTH]] is a more sensitive indicator than 24-hour [[urinary free cortisol]] (24-UFC) and low-dose [[dexamethasone suppression test]]
((Stroud A, Zhang J, McCormack AI. Diagnosing Cushing's disease in the context
of chronic kidney disease: A case report and literature review. Eur J Endocrinol.
2019 Aug 1. pii: EJE-19-0326.R2. doi: 10.1530/EJE-19-0326. [Epub ahead of print] 
PubMed PMID: 31382242.
)).