Undiagnosed Stroke and Neurological Manifestations in Chronic Kidney Disease: A Case Series
DOI:
https://doi.org/10.35870/ljit.v4i2.8785Keywords:
CARE, Chronic kidney disease, CT Scan, Neurology, StrokeAbstract
Chronic kidney disease (CKD) is associated with increased risk of neurological complications, but data describing these conditions and associated neuroimaging findings remain limited, particularly in resource-limited settings. This study aims to describe neurological manifestations and brain imaging abnormalities in hospitalized patients with CKD. We retrospectively analyzed 39 patients with CKD stages II–V who underwent neurological consultation and non-contrast head MSCT (multislice computed tomography) at a tertiary referral hospital in Sukoharjo, Indonesia, during 2025. Data were collected from medical records including demographics, clinical status, neurological complaints, imaging findings, and ICD-10 diagnoses. This case series was reported in accordance with CARE guidelines. The median age was 58 years (IQR 49–67), and 22 patients (56.4%) were male. Most patients had stage V CKD (84.6%), and 29 (74.4%) were on routine hemodialysis. Hypertension was present in 79.5% and diabetes mellitus in 41.0%. Non-contrast head MSCT revealed cerebrovascular pathology in 79.5% of patients, with cerebral infarction in 71.8%. The most common anatomical locations of infarction were the frontal lobe (35.7%), corona radiata (28.6%), and basal ganglia (25.0%). Cerebrovascular disease is highly prevalent among hospitalized CKD patients with neurological symptoms. Cerebral infarction was identified in approximately 71.8% of patients. The high discrepancy between clinical and radiological diagnoses suggests that stroke may be underrecognized in CKD patients, particularly when symptoms are attributed to metabolic encephalopathy. Early neuroimaging should be considered in CKD patients presenting with acute neurological symptoms.
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Andrews, T. D., Day, G. S., Irani, S. R., Kanekiyo, T., & Hickson, L. J. (2025). Uremic toxins, chronic kidney disease, and cognitive dysfunction. Journal of the American Society of Nephrology, 10–1681.
Capasso, G., Franssen, C. F. M., Perna, A. F., Massy, Z. A., Menzies, R. I., Zoccali, C., Tessitore, A., Nedergaard, M., Okusa, M. D., & Ortiz, A. (2025). Drivers and mechanisms of cognitive decline in chronic kidney disease. Nature Reviews Nephrology, 21(8), 536–552.
Chagas, Y. W., de Castro, P. A. S. V., & Simoes-e-Silva, A. C. (2025). Neuroinflammation in kidney disease and dialysis. Behavioural Brain Research, 483, 115465.
Cozza, M., & Boccardi, V. (2025). Cognitive impairment in chronic kidney disease: Mechanisms, clinical manifestations, and management strategies. Metabolic Brain Disease, 40(8), 1–14.
Ehindero, T., Tungsanga, S., Ye, F., Ibrahim, H. O., Lategan, I., Okpechi, I. G., & Bello, A. K. (2025). Trend in the incident risk of ischemic stroke among patients on kidney replacement therapy in Alberta, Canada: SA-PO0354. Journal of the American Society of Nephrology, 36(10S), 10–1681.
He, M., & Gillespie, A. (2025). Posterior reversible encephalopathy syndrome in chronic kidney disease: Incidence, outcomes, and risk factors in a national cohort. Kidney Medicine, 7(7), 101022.
Ito, H., & Mori, T. (2025). The brain-kidney axis in cerebral small vessel disease: Chronic kidney disease as an active mediator, not just a confounder. Hypertension Research, 48(12), 3309–3310.
Khrulev, A. E., Chernova, O. M., Grigoryeva, V. N., Shianova, N. A., Khruleva, N. S., & Mukhina, I. V. (2026). Cerebral neurodegeneration and cognitive impairment in patients on maintenance hemodialysis: The role of neuroglia and associated factors. Modern Technologies in Medicine, 18(1), 54.
Lee, T.-H. (2025). Intracerebral hemorrhage. Cerebrovascular Diseases Extra, 15(1), 1–8.
Merlino, L., Rainone, F., Chinnadurai, R., Hernandez, G., Tollitt, J., Battini, G. G., Colombo, P. M., Trivelli, M., Stewart, S., & Dunne, R. A. (2025). Health outcomes in chronic kidney disease patients with cognitive impairment or dementia: A global collaborative analysis. Clinical Kidney Journal, 18(1), sfae401.
Merlino, L., Tollitt, J., Dunne, R. A., & Kalra, P. A. (2025). Pathophysiology of cognitive impairment in chronic kidney disease. Current Opinion in Nephrology and Hypertension, 34(6), 459–468.
Molad, J., Miwa, K., Nash, P. S., Ambler, G., Best, J., Wilson, D., Hallevi, H., Fandler-Höfler, S., Eppinger, S., & Du, H. (2025). 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. Journal of Neurology, Neurosurgery & Psychiatry, 96(9), 842–851.
Nash, P. S., Best, J. G., Ambler, G., Wilson, D., Banerjee, G., Hostettler, I. C., Seiffge, D., Cohen, H., Yousry, T. A., & Salman, R. A.-S. (2023). Associations of renal function with cerebral small vessel disease and functional outcome in acute intracerebral haemorrhage: A hospital-based prospective cohort study. Journal of the Neurological Sciences, 452, 120743.
Ogasawara, K., Goncalves, O., Dominici, S., Araujo, B., Costa, M., & Almeida, K. (2025). Impact of chronic kidney disease on efficacy and safety outcomes of endovascular thrombectomy in acute ischemic stroke patients: A systematic review and meta-analysis (P5-13.011). Neurology, 104(7_Supplement_1), 5378.
Ortiz, A., Lees, J. S., Torra, R., Stel, V. S., Kramer, A., & Mark, P. B. (2026). The updated global burden of chronic kidney disease: One death every 20 seconds. Nephrology Dialysis Transplantation, gafg040.
Riley, D. S., Barber, M. S., Kienle, G. S., Aronson, J. K., von Schoen-Angerer, T., Tugwell, P., Kiene, H., Helfand, M., Altman, D. G., & Sox, H. (2017). CARE guidelines for case reports: Explanation and elaboration document. Journal of Clinical Epidemiology, 89, 218–235.
Rivera, R. F., Alibrandi, M. T. S., Foligno, N. E., Magagnoli, L., Ciceri, P., & Cozzolino, M. (2026). Uremic toxin-driven vascular calcification in chronic kidney disease: Molecular pathways and integrated phenotypes. Toxins, 18(2), 112.
Romadhon, Y. A. (2020). Manajemen stres terintegrasi sholat dan risiko penyakit kardiovaskuler: Kajian mengenai stres, depresi, anxietas, kualitas hidup, high sensitive C-reactive protein, transforming growth factor-1, intercellular adhesion molecule-1, dan interferon gamma. Universitas Sebelas Maret.
Wetmore, J. B., Kou, C., Khan, N. F., Barash, I., Atkins, G. B., Ramey, D. R., & Roetker, N. S. (2025). Major adverse thrombotic events and bleeding in stage 4-5 chronic kidney disease and dialysis-dependent end-stage kidney disease. Journal of Thrombosis and Haemostasis.
Wirayudha, Y., Kurniati, Y. P., & Nugraheni, F. E. (2024). Neurological deafness prevalence based on diabetes mellitus and gender. Journal La Mediehaltico, 5(2), 392–398.
Yang, J., Chen, X., Cao, X., Yang, H., Liu, P., Yin, X., Zhang, X., & Chen, Z. (2025). Chronic kidney disease as a catalyst for cerebral microbleeds: Understanding the underlying mechanisms and treatment approaches. Frontiers in Medicine, 12, 1578666.
Zhou, Z., Jardine, M. J., Li, Q., Neuen, B. L., Cannon, C. P., De Zeeuw, D., Edwards, R., Levin, A., Mahaffey, K. W., & Perkovic, V. (2021). Effect of SGLT2 inhibitors on stroke and atrial fibrillation in diabetic kidney disease. Stroke.
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Copyright (c) 2026 M Faris Ats-Tsabit, Arrizqi Hafidh Abdussalam, Ardyasih Ardyasih, Intan Permata Sari, Yuni Prastyo Kurniati, Yusuf Alam Romadhon
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