Ultrastructural Cutaneous Microvascular Pathology of Young Adults Aged up to 50 Years with Chronic Kidney Disease and Vascular Cognitive Impairment

Abstract

Background: Studies suggest a link between chronic kidney disease and cognitive impairment. Skin biopsy is hire in the study of leucoaraiosis since permit establish the responsible vascular pathology of subcortical white matter changes because the pathological hallmark is systemic. The aim was to study the ultrastructural changes of cutaneous small vessel of patients aged up to 50 years with chronic kidney disease (CKD) and vascular cognitive impairment (VCI). Methods: Clinical, laboratorial, cerebral imaging, neuropsycological evaluation for executive functions (Clox test), and skin biopsy to 4 patients aged up to 50 years with CKD and VCI were done. Skin biopsy was prepared for conventional transmission electron microscopy study. Results: Clinical diagnosis included hypertension, diabetes, and CKD in all cases. All cases developed VCI in a relatively short period. Small vessels study revealed small vessel disease type-degenerative microangiopathy. The principal findings were increase of wall–lumen ratio, thickened basal membrane, and collagen fibers proliferation. Conclusions: Cutaneous degenerative microangiopathy is matched with cerebral microvascular pathology and could be important for the development of cognitive impairment in young adults with CKD. The characterization of microvascular pathology in skin biopsies, in this type of patients, could contribute to the knowledge of some pathophysiological and therapeutical topics and possibly be useful in clinical setting. Added patients are needed to establish a complete characterization of microangiopathy.