transplantologiyaТрансплантологияTransplantologiya. The Russian Journal of Transplantation2074-05062542-0909IPO Association of Transplantologists10.23873/2074-0506-2021-13-4-382-397transplantologiya-614Research ArticleОБЗОРНЫЕ СТАТЬИ И ЛЕКЦИИREVIEW ARTICLES AND LECTURESХроническая болезнь почек как фактор риска острого инсультаChronic kidney disease as a risk factor for acute strokehttps://orcid.org/0000-0001-6849-1457РжевскаяО. Н.RzhevskayaO. N.

Ольга Николаевна Ржевская, д-р мед. наук, ведущий научный сотрудник отделения трансплантации почки и поджелудочной железы; профессор

129090, Москва, Большая Сухаревская пл., д. 3; 127473, Москва, Делегатская ул., д. 20, стр. 1

Olga N. Rzhevskaya, Dr. Sci. (Med.), Leading Researcher, Department of Kidney and Pancreas Transplantation, Department of Kidney and Pancreas Transplantation; Professor

3 Bolshaya Sukharevskaya Sq., Moscow 129090; 1 Bldg. 20 Delegatskaya St., Moscow 127473

dr_rzhevskayaolga@mail.ruhttps://orcid.org/0000-0003-0718-5258МоисееваА. Ю.MoiseevaA. Y.

Александра Юрьевна Моисеева, клинический ординатор по специальности «Кардиология»

129090, Москва, Большая Сухаревская пл., д. 3 

Aleksandra Yu. Moiseeva, Clinical Resident in Cardiology

3 Bolshaya Sukharevskaya Sq., Moscow 129090

moiseyeva.alexandra.y@yandex.ruhttps://orcid.org/0000-0002-4940-9574ЭсауленкоА. Н.EsaulenkoA. N.

Анна Николаевна Эсауленко, клинический ординатор по специальности «Кардиология»

129090, Москва, Большая Сухаревская пл., д. 3

Anna N. Esaulenko, Clinical Resident in Cardiology

3 Bolshaya Sukharevskaya Sq., Moscow 129090

aesaulenko95@mail.ruhttps://orcid.org/0000-0001-9019-9567ПинчукА. В.PinchukA. V.

Алексей Валерьевич Пинчук, д-р мед. наук, заведующий научным отделением трансплантации почки и поджелудочной железы; доцент; заведующий организационно-методическим отделом по трансплантологии

129090, Москва, Большая Сухаревская пл., д. 3; 127473, Москва, Делегатская ул., д. 20, стр. 1; 115184, Москва, Большая Татарская ул., д. 30

Aleksey V. Pinchuk, Dr. Sci. (Med.), Head of the Scientific Department of Kidney and Pancreas Transplantation; Associate Professor; Head of the Organizational and Methodological Department for Transplantology

3 Bolshaya Sukharevskaya Sq., Moscow 129090; 1 Bldg. 20 Delegatskaya St., Moscow 127473; 30 Bolshaya Tatarskaya St., Moscow 115184

PinchukAV@sklif.mos.ruhttps://orcid.org/0000-0002-6229-8629АлиджановаХ. Г.AlidzhanovaKh. G.

Хафиза Гафуровна Алиджанова, д-р мед. наук, старший преподаватель учебного центра, старший научный сотрудник отделения неотложной клинической кардиологии с методами неинвазивной функциональной диагностики

129090, Москва, Большая Сухаревская пл., д. 3

Khafiza G. Alidzhanova Dr. Sci. (Med.), Senior Lecturer of the Training Center, Senior Researcher of the Department of Emergency Clinical Cardiology with Methods of Non-invasive Functional Diagnosis

3 Bolshaya Sukharevskaya Sq., Moscow 129090

AlidzanovaHG@sklif.mos.ruГБУЗ «НИИ скорой помощи им. Н.В. Склифосовского ДЗМ»; Кафедра трансплантологии и искусственных органов ФГБОУ ВО МГМСУ им. А.И. Евдокимова МЗ РФРоссияN.V. Sklifosovsky Research Institute for Emergency Medicine; Department of Transplantology and Artificial Organs, A.I. Yevdokimov Moscow State University of Medicine and DentistryRussian FederationГБУЗ «НИИ скорой помощи им. Н.В. Склифосовского ДЗМ»РоссияN.V. Sklifosovsky Research Institute for Emergency MedicineRussian FederationГБУЗ «НИИ скорой помощи им. Н.В. Склифосовского ДЗМ»; Кафедра трансплантологии и искусственных органов ФГБОУ ВО МГМСУ им. А.И. Евдокимова МЗ РФ; ГБУ «НИИ организации здравоохранения и медицинского менеджмента ДЗМ»РоссияN.V. Sklifosovsky Research Institute for Emergency Medicine; Department of Transplantology and Artificial Organs, A.I. Yevdokimov Moscow State University of Medicine and Dentistry; Research Institute for Healthcare Organization and Medical ManagementRussian Federation202115122021134382397Copyright © Ржевская О.Н., Моисеева А.Ю., Эсауленко А.Н., Пинчук А.В., Алиджанова Х.Г., 20212021Ржевская О.Н., Моисеева А.Ю., Эсауленко А.Н., Пинчук А.В., Алиджанова Х.Г.Rzhevskaya O.N., Moiseeva A.Y., Esaulenko A.N., Pinchuk A.V., Alidzhanova K.G.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.jtransplantologiya.ru/jour/article/view/614

Одной из актуальных тем нефрологии, неврологии и кардиологии является ведение и лечение пациентов с хронической болезнью почек и инсультом. Пациенты c хронической болезнью почек имеют риск как тромботических осложнений, так и кровотечений, у них высок риск как ишемического, так и геморрагического инсульта. Гемодиализ, вызывая резкие гемодинамические и биохимические изменения, приводит к «стрессу» сосудистой системы головного мозга, повышая риск развития инсульта; трансплантация почки за счет восстановления функции органа уменьшает риск инсульта. Хроническая болезнь почек значительно ухудшает исход инсульта, ограничивая лечение из-за снижения клиренса лекарств и побочных эффектов. Хроническая болезнь почек и инсульт имеют существенные социально-экономические последствия. Пациентов с терминальной стадией хронической болезни почек, как правило, не включают в клинические исследования, для них не разработана тактика лечения инсульта.

В данной работе рассматривается взаимосвязь почек и головного мозга, вопросы патофизиологии и эпидемиология инсульта при всех стадиях хронической болезни почек, после трансплантации почки и обсуждается тактика ведения и лечения пациентов с хронической болезнью почек с инсультом. Изучение факторов, ответственных за высокую распространенность поражения головного мозга при хронической болезни почек, позволит разработать новые способы лечения.

One of the most relevant issues of nephrology, neurology, and cardiology is the management and treatment of patients with chronic kidney disease and stroke. Patients with chronic kidney disease have a risk of both thrombotic complications and bleeding, and they have a high risk of both ischemic and hemorrhagic stroke. Chronic kidney disease significantly worsens the outcome of stroke by limiting the treatment due to reduced drug clearance and side effects. Hemodialysis which causes drastic hemodynamic and biochemical changes leads to the "stress" of the cerebral vascular system, increasing the risk of stroke; kidney transplantation reduces the risk of stroke due to functional recovery. Chronic kidney disease and stroke have significant socio-economic consequences. Patients with end-stage chronic kidney disease, as a rule, are not included in clinical trials; and stroke treatment tactics have not been developed for them. This review examines the interaction between kidneys and brain, the pathophysiology and epidemiology of stroke in all stages of chronic kidney disease, after kidney transplantation and discusses the management and treatment of chronic kidney disease patients with stroke.

The investigation of the factors responsible for the high prevalence of brain lesions in chronic kidney disease will allow developing new treatment methods.

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The authors declare that there are no conflicts of interest present.