Recently, it has been noted that the hemodynamics of the vascular beds of the brain and the kidney are similar, and attention has been focused on the brain-kidney interaction. [6][7][8] Additionally, a similar vascular structure has been observed in the penetrating arteries of the brain and the juxtamedullary afferent arterioles of the kidney.7 Albuminuria, a marker of chronic kidney disease, is associated with an increased risk of incident stroke and unfavorable long-term outcomes. 9 Moreover, albuminuria may indicate vascular endothelial dysfunction, which leads to neuronal damage via blood-brain barrier impairment. In this study, we sought to explore whether albuminuria can be used to identify neurological deterioration and infarct volume expansion in patients with acute small subcortical infarcts in the LSA territory.
Materials and MethodsThis retrospective study included consecutive patients with a diagnosis of single small subcortical infarcts localized in the LSA territory Background and Purpose-Albuminuria, a marker of chronic kidney disease, is associated with an increased risk of incident stroke and unfavorable long-term outcomes. However, the association of albuminuria with short-term outcomes and change in infarct volume in patients with acute small subcortical infarction remains unknown. Methods-We retrospectively reviewed 85 consecutive patients with acute small subcortical infarcts in the lenticulostriate artery territory who were admitted to our stroke center within 24 hours of symptom onset and underwent serial diffusionweighted imaging (DWI). Albuminuria was determined based on the urinary albumin-to-creatinine ratio obtained from a first morning spot urine after admission. Infarct volume was measured on axial sections of the initial and follow-up DWI. Early neurological deterioration (END) was defined as an increase of ≥2 points in the National Institutes of Health Stroke Scale score during the first 5 days after admission. Results-Albuminuria (UACR ≥30 mg/g creatinine) was observed in 14 of 18 patients with END (77.8%) and in 25 of 67 patients without END (37.3%), P=0.002. Multivariate logistic regression analysis revealed that albuminuria was associated with END after adjustment for age, low estimated glomerular filtration rate (<60 mL/min per 1.73 m 2 ), and infarct volume on initial DWI (odds ratio, 6.64; 95% confidence interval, 1.62-27.21; P=0.009). In addition, albuminuria was an independent predictor of increase in infarct volume using multivariate linear regression analysis (β coefficient=0.217; P=0.038). Conclusions-Our findings suggest that albuminuria is associated with END and infarct volume expansion in patients with small subcortical infarcts in the lenticulostriate artery territory. (Stroke. 2014;45:587-590.)Key Words: albuminuria ◼ acute stroke ◼ diffusion-weighted imaging ◼ infarct volume ◼ lenticulostriate arteries
Impact of Albuminuria on Early Neurological Deterioration and Lesion Volume Expansion in Lenticulostriate Small InfarctsToshitaka Umemura, MD, PhD; Joe Senda, MD,...