Abstract
Background and purpose: Cerebral small vessel disease is associated with chronic kidney disease. Although cerebral microbleeds (CMB) are common in patients with lacunar stroke, the association between CMB and renal impairment remains unclear. The aim of this study was to clarify whether CMB are associated with renal impairment in patients with acute lacunar stroke. Methods: We evaluated consecutive first-ever lacunar stroke patients who were admitted to our hospital within 24 hours after stroke onset. Lacunar infarcts were defined as <15 mm in diameter detected on initial diffusion-weighted imaging scans and depended on the criteria for small artery occlusion based on the TOAST (Trial of ORG 10172 in Acute Stroke Treatment) classification. CMB were defined as a focal area of signal loss in brain parenchyma <5 mm on T2*-weighted imaging scans. We divided patients into two groups according to the presence or absence of CMB. Results: Among 152 patients (66% male, mean age 69 years), 45 (30%) had CMB. The presence of silent lacunar infarcts (SLI; 87% vs 41%, P <0.001), white matter disease (WMD; 67% vs 26%, P <0.001), and hypertension (84% vs 66%, P <0.05) were higher and estimated glomerular filtration rate (eGFR) on admission (67.7 vs 79.0 mL/min/1.73 m 2 , P <0.01) was lower in patients with CMB than in those without. The frequency of CMB showed a significant difference among tertiles of eGFR (highest, middle, and lowest; 14%, 35%, and 40%, P <0.01). On multivariable logistic regression analysis, SLI (odds ratio, 95% confidence interval; 11.1, 3.8-37.7), hypertension (5.1, 1.6-18.9), WMD (4.6, 1.6-13.8), eGFR on admission (lowest and middle tertiles vs highest tertile, 3.3, 1.1-10.9), NIHSS score on admission (1.3, 1.0-1.6), and diabetes mellitus (0.1, 0.04-0.41) were independently associated with CMB. Conclusions: In lacunar stroke patients, the presence of CMB should be associated with renal impairment.
Published Version
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