Chronic kidney disease

• Linear and Non-linear Association of Chronic Kidney Disease with Retina and Choroid Vessel Density in Diabetes: A Prospective Study
• Carotid artery calcification as a predictor of systemic vascular events
• Two decades of trends in nontraumatic intracerebral hemorrhage care: A nationwide analysis
• Kidney function in acromegaly: evidence from a long-term observational study
• Urgent Carotid Artery Revascularization Fraught with Higher Rates of Neurovascular Events In Symptomatic Carotid Artery Stenosis
• Liquid Embolic Volume Correlates With Improved Chronic Subdural Hematoma Resolution After Middle Meningeal Artery Embolization
• Ultrasmall platinum single-atom enzyme alleviates oxidative stress and macrophage polarization induced by acute kidney ischemia-reperfusion injury through inhibition of cell death storm
• Increased risk of recurrent stroke in patients with impaired kidney function: results of a pooled analysis of individual patient data from the MICON international collaboration

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 ¹⁾.

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 testing 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 ²⁾.