Early microalbuminuria as a clinical marker for acute cerebral small vessel infarction

Zhai, Zhiyong; Feng, Juan

doi:10.1080/01616412.2018.1545413

Cited by 6 publications

(9 citation statements)

References 25 publications

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“…Microalbuminuria, as a sign of diabetic nephropathy and a marker of endothelial dysfunction, independently increases the incident stroke risk and is associated with lacunar strokes as a result of cerebral small vessel disease. 40 Diabetic nephropathy has also been shown to negatively influence functional outcome of IS, potentially through its association with severe leukoaraiosis. 41 Though not assessed in the present study, these findings suggest an association between renal microvascular complication of DM and lacunar stroke, potentially as a result of small vessel disease linking these clinical manifestations.…”

Section: Discussionmentioning

confidence: 99%

Diabetes in ischaemic stroke in a regional Australian hospital: uncharted territory

Low

O'Connor

et al. 2022

Internal Medicine Journal

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Background Stroke and diabetes mellitus (DM) are significant interrelated healthcare issues but there is a dearth of data on the prevalence of DM among Australia's regional stroke population. Aims We aimed to determine the prevalence of DM in stroke patients at a large regional centre, including subanalyses on stroke subtypes, glycaemic control and renal function in ischaemic stroke (IS). Methods We conducted a retrospective analysis of all patients (n = 323) with IS or transient ischaemic attack (TIA) admitted to Ballarat Base Hospital from January 2015 to December 2016. Demographic data, cardiovascular risk factors, aetiology/territory of IS, pre‐morbid DM status, indicators of glycaemic control and renal impairment were recorded. Results DM was present in 28.5% of IS and TIA patients, including 4% being newly diagnosed. Among diabetic IS patients, 45.3% had poor glycaemic control (HbA1c ≥7.0%) while 16% had moderate to severe renal impairment (estimated glomerular filtration rate of <30). The majority of IS were partial anterior circulation stroke (53.4%) and cardioembolism was the commonest mechanism (43.5%). We found no significant association between DM and a specific stroke location or mechanism. Conclusions Almost one‐third of IS/TIA patients had DM, with a significant proportion showing poor glycaemic control. The DM prevalence in our cohort was comparable with reported rates from other developed countries. Although we found no association between DM and a particular stroke type or mechanism, it is likely a reflection of our cohort size. Our study demonstrated that DM, as a significant risk factor in IS, warrants early detection and better management strategies.

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Section: Discussionmentioning

confidence: 99%

Diabetes in ischaemic stroke in a regional Australian hospital: uncharted territory

Low

O'Connor

et al. 2022

Internal Medicine Journal

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“…Few studies have examined the association of albuminuria with all different stroke sub-types simultaneously, and only one of them had a prospective design [14,36].…”

Section: Comparison With Earlier Studiesmentioning

confidence: 99%

Low grade albuminuria as a risk factor for subtypes of stroke - the HUNT Study in Norway

et al. 2020

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Background and purpose Albuminuria is a marker for endothelial dysfunction and knowledge on its association with stroke and stroke subtypes are limited. Methods Corresponding data from 7261 participants of the population-based HUNT2 study (1995–1997) was linked with hospital records, identified all patients registered and diagnosed with a first-time stroke. Each diagnosis was validated by reviewal of the medical record appertaining to the individual. We then applied Cox proportional hazard models to estimate the hazard ratios (HRs) for the association between albuminuria (measured as albumin-to-creatinine-ratio, ACR) and diagnosis of stroke and stroke subtypes. Results 703 (9.7%) participants developed a first ischemic stroke during a median follow-up of 15 years. Higher albuminuria was associated with a higher rate for ischemic stroke and the risk rose steadily with increasing ACR (15% increment per unit increase in ACR concentration in mg/mmol). In the fully adjusted model, the HR for all ischemic strokes was 1.56 (95% CI 1.24–1.95) for those with an ACR ≥3 mg/mmol compared to participants with an ACR < 1 mg/mmol. Overall, increasing ACR was associated with a higher risk of all ischemic stroke subtypes. This was seen to be strongest for lacunar stroke (HR 1.75, CI 1.12–2.72, p = 0.019), and also for stroke of undetermined etiology (HR 1.53, CI 1.11–2.11, p = 0.009) and those caused by atherosclerosis in the large arteries (HR 1.51, CI 0.78–2.94, p = 0.186) than for cardio-embolic stroke (HR 1.22, CI 0.64–2.3, p = 0.518). Conclusions Albuminuria is an important risk factor, potentially already at low grade, for ischemic stroke especially for lacunar subtype. Measuring albuminuria is both cheap and readily available. This offers the opportunity to evaluate the risk for endothelial dysfunction and thus the subsequent risk for stroke and cerebral small vessel disease.

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“…Endothelial dysfunction may be the fundamental step in the deteriorating of lacunar infarction. 15 16 17 …”

Section: Introductionmentioning

confidence: 99%

Urine Protein Levels Predict Future Development of Cerebral Infarction in Koreans

Lee

Ryoo

2022

Yonsei Med J

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Purpose Proteinuria is a clinical sign of adverse cardiovascular outcomes, including stroke. We aimed to assess the relationship between proteinuria and the occurrence of cerebral infarction. Materials and Methods In total, 208854 Koreans who participated in the 2009 medical examination were followed up until 2013 using the database of the National Health Insurance Service. The results of urine dipstick tests were utilized to assess proteinuria as absent, 1+, 2+, or ≥3+. The International Classification of Diseases code 163 was used to document cerebral infarction. Results Between 2009 and 2013, 2383 cases (1.14%) of cerebral infarction occurred during 912772.9 person-years of follow-up. Hazard ratios for incident cerebral infarction increased with inceasing amounts of urine protein from 1.53 (1.23–1.90) in group 2 (1+), 1.67 (1.22–2.28) in group 3 (2+), and 2.66 (1.79–3.96) in group 4 (≥3+), compared to the reference group with little to no detectable urine protein ( p <0.001, respectively). Conclusion An increase in urine protein levels was significantly related to the risk of developing cerebral infarction. Our results suggest that proteinuria might be a potential risk factor for cerebral infarction and that urine dipstick test analysis may be clinically useful for predicting stroke.

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Early microalbuminuria as a clinical marker for acute cerebral small vessel infarction

Cited by 6 publications

References 25 publications

Diabetes in ischaemic stroke in a regional Australian hospital: uncharted territory

Diabetes in ischaemic stroke in a regional Australian hospital: uncharted territory

Low grade albuminuria as a risk factor for subtypes of stroke - the HUNT Study in Norway

Urine Protein Levels Predict Future Development of Cerebral Infarction in Koreans

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