title: Impact of albuminuria on early neurological deterioration and lesion volume expansion in lenticulostriate small infarcts.
abstract: OBJECTIVE
  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 diffusion-weighted 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 m2), 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.
authors.affiliation: From the Departments of Neurology (T.U., Y.F., T.S.), Radiology (S.M.), Diabetes and Endocrine Internal Medicine (T.K.), Chubu Rosai Hospital, Nagoya, Japan; and Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Japan (J.S., G.S.).
authors.forename: Toshitaka
authors.initials: T
authors.lastname: Umemura
authors.forename: Joe
authors.initials: J
authors.lastname: Senda
authors.forename: Yuki
authors.initials: Y
authors.lastname: Fukami
authors.forename: Shinichi
authors.initials: S
authors.lastname: Mashita
authors.forename: Takahiko
authors.initials: T
authors.lastname: Kawamura
authors.forename: Toshimasa
authors.initials: T
authors.lastname: Sakakibara
authors.forename: Gen
authors.initials: G
authors.lastname: Sobue
mesh_terms: D000368:Aged; D000419:Albuminuria / Q000150:complications*; D020144:Basal Ganglia Cerebrovascular Disease / Q000150:complications* / Q000473:pathology*; D002544:Cerebral Infarction / Q000473:pathology; D016001:Confidence Intervals; D038524:Diffusion Magnetic Resonance Imaging; D018450:Disease Progression; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007091:Image Processing, Computer-Assisted; D016015:Logistic Models; D008297:Male; D009422:Nervous System Diseases / Q000150:complications* / Q000473:pathology*; D016017:Odds Ratio; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
keywords: acute stroke; albuminuria; diffusion-weighted imaging; infarct volume; lenticulostriate arteries