VCAM1 and uremia: Repeated bursts of such power activate endothelial NADPH-oxidase and NF-κB, up-regulating ICAM-1, VCAM-1, and pro-inflammatory cytokines; in uremia this cascade is amplified, further weakening the blood–brain barrier and permitting neurotoxic proteins and immune cells to invade the parenchyma [27, 28].