Background and Purpose-Chronic kidney disease (CKD) is increasingly recognized as an independent risk factor for cardiovascular disease and stroke. Our aim was to examine the association between estimated glomerular filtration rate (GFR) and stroke outcome and to assess whether CKD and its severity affect stroke outcome in a large cohort of unselected patients with acute stroke. Methods-We examined the association between baseline estimated GFR and CKD and 1-year outcomes in 821 consecutive patients with acute stroke (ischemic or hemorrhagic). GFR was estimated by 2 methods: the Modification of Diet in Renal Disease and the Mayo Clinic quadratic equation. An estimated GFR rate Յ60 mL/min/1.73 m 2 defined CKD. Results-Odds ratios (95% CI) for death across levels of estimated GFR based on both equations were estimated. CKD was present in 36% (nϭ291)
SUMMARY Seventy-two children with the haemolytic-uraemic syndrome were seen between 1969 and 1980 at The Hospital for Sick Children and Guy's Hospital, London. They probably constitute the majority of such cases in south-east England during that period. Boys and girls were affected equally, the mean age at presentation was 3* 5 years, and a peak incidence of the disorder in summer months was observed. In 52 (72 %) there was a history of diarrhoea at onset. Fifty-seven (78 %) were managed by dialysis. Fifty (70 %) of the 72 children had a favourable outcome with complete recovery, 3 (4 %) died in the acute phase of the illness, 8 (11 %) had residual hypertension or chronic renal failure, and 11 (16 %) never recovered renal function. The probability of complete recovery of renal function was analysed by logistic regression which indicated that younger age, presentation in the summer months, diarrhoea at onset and, in those patients who were dialysed, a short prodromal illness were associated with a good outcome. Further analysis of the interaction among these variables in the patient group as a whole indicated that diarrhoea favoured a good outcome among boys but not girls.In 1955 Gasser et al. described the association of an acute haemolytic anaemia, thrombocytopenia, and renal failure.' The disorder is now known as the haemolytic-uraemic syndrome (HUS), and is recognised as a major cause of acute renal failure in children. It is more common under age 4 years, and is often associated with a history of diarrhoea or upper respiratory tract infection.2-7 There appear to be endemic areas-such as Argentina6 and the Netherlands7-and elsewhere the disorder often occurs in mini-epidemics. It is known that although most affected children recover a few do not, and this heterogeneity of outcome is a major complicating factor in the analysis of results of treatment or the design of prospective therapeutic trials.In a previous analysis of 34 cases in England, a poor outcome was associated with persistent anaemia, hepatosplenomegaly, purpura, and the absence of antecedent diarrhoea.8 In order to analyse the natural history and predictive variables of the disorder as seen in children resident in south-east England, we have reviewed the case records of all the 72 such children admitted to the two renal units in London responsible for the care of most children with acute renal failure in the area.
101Patients and methods HUS was diagnosed in children with renal failure, a haemolytic anaemia with fragmented cells and thrombocytopenia in whom other causes, particularly septicaemia, had been excluded. The records of the 72 such children
Purpose: Platelets play a critical role in the pathogenesis of acute brain ischaemia. We studied the association between the degree of inhibition of platelet function by aspirin (ASA) and the severity and outcome of acute brain ischaemia. Methods: Platelet responsiveness to ASA was assessed in patients with acute brain ischaemia, treated with ASA since hospital admission. The degree of ASA responsiveness was assessed by optical aggregometry and categorized into patients with good response, partial response and complete unresponsiveness to ASA (good responders, partial responders and non-responders, respectively). An additional evaluation of responsiveness to ASA was performed by Impact-R (cone and platelet analyzer). Patients underwent serial clinical assessment during hospitalization, at discharge and during follow-up. Results: Among 105 patients (mean age 63 ± 12 years; 66% men), impaired ASA responsiveness at baseline as assessed by aggregometry was associated with increased stroke severity at baseline, unfavourable clinical course, and poor functional outcome during follow-up (p < 0.05 for all). Age-adjusted odds ratios in non-responders compared to good responders were 9.8 for severe stroke on admission (95% CI 2.8–34.9), 3.1 for lack of early clinical improvement (95% CI 1.1–8.8) and 8.6 for poor functional outcome during follow-up (95% CI 2.4–30.4). Less robust trends were observed with the Impact-R. Conclusions: Impaired responsiveness to ASA in acute brain ischaemia is common and is associated with worse neurological deficits at stroke onset, early clinical deterioration and poorer functional outcome. The clinical significance of these findings requires further evaluation in larger longitudinal studies.
A high proportion of RI remains unrecognized among hospitalized patients with HF. As co-morbid RI has important prognostic and therapeutic implications, patients with HF may benefit from routine assessment of GFR.
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