Impaired kidney function and cerebral microbleeds in patients with acute ischemic stroke

Cho, A. H.; Lee, S. B.; Han, Shu; Shon, Young-Min; Yang, Dong; Kim, B. S.

doi:10.1212/wnl.0b013e3181c1defa

Cited by 94 publications

(69 citation statements)

References 14 publications

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“…An association between cerebral microbleeds and atherosclerosis T Shimoyama et al Impaired kidney function was associated with CMBs in this study, which was in agreement with the finding that a low GFR is associated with CMBs. 25 We postulated that endothelial dysfunction might have a key role in impaired kidney function and in the development of CMBs. The kidneys and the brain are early targets for damage by elevated blood pressure.…”

Section: Discussionmentioning

confidence: 99%

Stroke patients with cerebral microbleeds on MRI scans have arteriolosclerosis as well as systemic atherosclerosis

et al. 2012

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Cerebral microbleeds (CMBs) are recognized as a manifestation of arteriolosclerosis in cerebral small vessels. However, little is known regarding whether stroke patients with CMBs often have systemic atherosclerosis. The aim of the present study was to elucidate this issue using the cardio-ankle vascular index (CAVI), a new index of systemic atherosclerosis, in acute ischemic stroke patients. We prospectively studied 105 patients (71 males, median age ¼ 70.0 years) with acute ischemic stroke. All of the patients were examined using T2*-weighted gradient echo magnetic resonance imaging (MRI) to look for and assess the CMBs and using fluid-attenuated inversion recovery to evaluate white matter hyperintensity (WMH). We assigned the patients into CMB and non-CMB groups and compared the clinical characteristics of these groups. The factors associated with CMBs were investigated using multivariate logistic regression analysis. T2*-weighted gradient echo MRI revealed CMBs in 47 patients (44.8%) and no CMBs in 58 patients (55.2%). The CAVI was significantly higher in the CMBs group (10.5 vs. 8.6, Po0.001).In the multivariate logistic regression analysis, CAVI per one point increase (odds ratio (OR), 1.50; 95% confidence interval (CI), 1.12-2.00; P ¼ 0.006), advanced WMH (OR, 4.78; 95% CI, 1.55-14.74; P ¼ 0.006) and impaired kidney function (OR, 3.31; 95% CI, 1.16-9.81; P ¼ 0.031) were independent factors associated with the presence of CMBs. A high CAVI was independently associated with CMBs in patients with acute ischemic stroke. Our results indicated that ischemic stroke patients with CMBs may have cerebral arteriolosclerosis as well as systemic atherosclerosis.

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Section: Discussionmentioning

confidence: 99%

Stroke patients with cerebral microbleeds on MRI scans have arteriolosclerosis as well as systemic atherosclerosis

et al. 2012

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“…CKD is also associated with cerebral small-vessel disease and with white matter hyperintensity, highlighting the growing importance of kidney disease as a possible determinant of cerebrovascular disease and/or as a marker of microangiopathy and ultimately with long-term survival [13,14,16]. Indeed, kidney and brain are end organs that are vulnerable to hypertensive damage [24], and a higher rate of cerebral microbleeds is identified by MRI in patients with acute ischemic stroke [15]. Patients with moderate/severe CKD in our cohort were more often prescribed antiplatelets and more often had cerebral leukoariosis.…”

Section: Discussionmentioning

confidence: 99%

“…There is growing evidence for an association between chronic kidney disease (CKD) and adverse cardiovascular events [4,5,6]. CKD is associated also with increased risk of bleeding after coronary interventions [7,8,9], acute myocardial infarction [10], coronary artery bypass surgery [11] and use of anticoagulation [12], as well as with cerebral small-vessel disease, white matter hyperintensities and microbleeds [13,14,15,16]. We have, therefore, hypothesized that in the setting of ICH, CKD is associated with larger initial hematoma volume and poor outcome.…”

Section: Introductionmentioning

confidence: 99%

Chronic Kidney Disease in Patients with Acute Intracerebral Hemorrhage: Association with Large Hematoma Volume and Poor Outcome

Molshatzki

Orion²,

Tsabari³

et al. 2010

Cerebrovasc Dis

103

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Background: Chronic kidney disease (CKD) is associated with both a risk of adverse vascular outcome and a risk of bleeding. We have tested the hypothesis that in the setting of an acute intracerebral hemorrhage (ICH), CKD is associated with poor outcome and with larger hematoma volume. Methods: We examined the association between CKD and ICH characteristics and outcome within a prospective cohort study of consecutive patients hospitalized with an acute stroke and followed for 1 year. CKD was categorized by the estimated baseline glomerular filtration rate into moderate/severe impairment (<45), mild impairment (45–60) and no impairment (>60 ml/min/1.73 m²). Results: Among 128 patients with an ICH (mean age = 71.7 ± 12.3 years, 41.4% women) 46.1% had CKD (23.4% mild and 22.7% moderate/severe). Patients with moderate/severe impairment had >4-fold adjusted hazard ratio for mortality over 1 year (4.29; 95% CI = 1.69–10.90) compared to patients with no impairment. The hematoma volumes [median (25–75%)] were 15.3 ml (5.4–37.5) in patients with no impairment, 16.6 (6.8–36.9) in mild impairment and 50.2 (10.4–109.1) in moderate/severe impairment (p = 0.009). The location of the hematoma was lobar in 12% with no impairment, 17% with mild impairment and 39% with moderate/severe impairment (p = 0.02). Patients with moderate/severe impairment exhibited a 2.3-fold higher hematoma volume (p = 0.04) and a >6-fold higher odds of lobar location (95% CI = 1.59–24.02) as compared to no impairment. Further adjustment for antiplatelet use and for presence of leukoaraiosis attenuated the association with hematoma volume (p = 0.15), while moderate/severe impairment was associated with an adjusted OR of 5.35 (95% CI = 1.18–24.14) for lobar location. Conclusions: Presence of moderate/severe CKD among patients with ICH is associated with larger, lobar hematomas and with poor outcome.

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“…50 In two other studies performed in patients with ischemic stroke, similar associations between chemical markers of CKD and cerebral microbleeds have been observed. 51,52 Interestingly, Watanabe also found a high incidence of microbleeds in patients undergoing maintenance hemodialysis but failed to find any correlation between the duration of hemodialysis and the prevalence of microbleeds. The author concluded that the high proportion of patients with microbleeds in this population was caused by other risk factors, possibly arterial hypertension and uremic toxins, rather than maintenance hemodialysis per se.…”

Section: Brain Lesions In Ckd Patientsmentioning

confidence: 99%

Cognitive Disorders and Dementia in CKD

Bugnicourt

Godefroy

Chillon

et al. 2013

Journal of the American Society of Nephrology

494

431

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Epidemiologic data suggest that individuals at all stages of CKD have a higher risk of developing cognitive disorders and dementia. This risk is generally explained by the high prevalence of both symptomatic and subclinical ischemic cerebrovascular lesions. However, other potential mechanisms, including direct neuronal injury by uremic toxins, could also be involved, especially in the absence of obvious cerebrovascular disease. We discuss the prevalence and characteristics of cognitive disorders and dementia in patients with CKD, brain imaging findings, and traditional and nontraditional risk factors. Understanding the pathophysiologic interactions between renal impairment and brain function is important in order to minimize the risk for future cognitive impairment.

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Impaired kidney function and cerebral microbleeds in patients with acute ischemic stroke

Abstract: Impaired kidney function is associated with the presence of cerebral microbleeds in acute ischemic stroke.

Cited by 94 publications

References 14 publications

Stroke patients with cerebral microbleeds on MRI scans have arteriolosclerosis as well as systemic atherosclerosis

Stroke patients with cerebral microbleeds on MRI scans have arteriolosclerosis as well as systemic atherosclerosis

Chronic Kidney Disease in Patients with Acute Intracerebral Hemorrhage: Association with Large Hematoma Volume and Poor Outcome

Cognitive Disorders and Dementia in CKD

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