Chronic Kidney Disease and Cerebral Microbleeds: Pathophysiological Insights and Implications for Nephrology

Chronic kidney disease (CKD) is an increasing global health burden and is a recognized risk factor for vascular injury. Cerebral microbleeds (CMB), a radiological marker of microvascular hemorrhage in the brain, are more prevalent in CKD and are predictive of stroke and cognitive decline. This review integrates evidence from epidemiologic studies, neuropathological investigations, and experimental models to elucidate the mechanistic links between CKD and CMB. Key pathways include uremic toxin-induced endothelial injury, vascular calcification and blood pressure variability. These abnormalities weaken microvascular integrity and accelerate vascular remodeling, ultimately promoting microvascular rupture and CMB formation. Evidence indicates that CKD is an independent risk factor for CMB formation, even after adjustment for conventional vascular risk factors. Recognizing CKD-related CMB as a significant cerebrovascular complication has important implications for prevention of stroke and cognitive decline. Incorporating CMB assessment into CKD care and implementing targeted vascular protection and uremic toxin-lowering strategies may enhance brain health outcomes.