Deep Cerebral Microbleeds and Renal Dysfunction in Patients with Acute Lacunar Infarcts.
BACKGROUND
Cerebral small-vessel disease (SVD) is associated with renal dysfunction such as chronic kidney disease. Although cerebral microbleeds (CMBs) are common in patients with acute lacunar infarcts (ALI), the association between renal dysfunction and CMBs in such patients remains unclear.


METHODS
Between April 2007 and March 2013, we evaluated consecutive first-ever ALI patients, who were admitted to our hospital within 24 hours of stroke onset. CMBs were defined as focal areas of signal loss in brain parenchyma less than 5 mm on T2(∗)-weighted gradient-echo imaging. Renal dysfunction was defined as an estimated glomerular filtration rate less than 60 mL/minute/1.73 m(2) on admission. Correlations between renal dysfunction and the presence (model 1) and location of CMBs (model 2; any deep or infratentorial CMBs) were determined by multivariable logistic regression analyses.


RESULTS
Among 152 patients (33.6% men; mean age, 67.6 years), 53 had CMBs. Patients with CMBs were older (69.9 versus 66.3 years, P = .03) and had a higher frequency of white matter hyperintensity (WMH; 62.3% versus 25.3%, P < .001), silent lacunar infarcts (SLI; 75.5% versus 43.3%, P < .001), and renal dysfunction (41.5% versus 22.2%, P = .015) than those without CMBs. On multivariable analyses, renal dysfunction (odds ratio, 95% confidence interval; model 1: 2.38, 1.02-5.66; model 2: 2.78, 1.16-6.81), WMH (3.87, 1.76-8.80; 3.72, 1.64-8.71), SLI (3.85, 1.71-9.14; 4.20, 1.77-10.8), and diabetes mellitus (.26, .09-.63; .24, .08-.63) were independently associated with CMBs.


CONCLUSIONS
In patients with ALI, renal dysfunction was positively associated with CMBs independent of cerebral SVD.
Department of Stroke Medicine, Kawasaki Medical School, Kurashiki, Okayama, Japan; Center for Comprehensive Care and Research on Memory Disorders, National Center for Geriatrics and Gerontology, Obu, Aichi, Japan. Electronic address: sajink@nifty.com.
Naoki
N
Saji
Department of Neurological Science, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan.
Kazumi
K
Kimura
Department of Stroke Medicine, Kawasaki Medical School, Kurashiki, Okayama, Japan.
Yoshiki
Y
Yagita
Department of Stroke Medicine, Kawasaki Medical School, Kurashiki, Okayama, Japan.
Junichi
J
Uemura
Department of Neurological Science, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan.
Junya
J
Aoki
Department of Neurological Science, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan.
Takahiro
T
Sato
Center for Comprehensive Care and Research on Memory Disorders, National Center for Geriatrics and Gerontology, Obu, Aichi, Japan.
Takashi
T
Sakurai
D000368:Aged; D000369:Aged, 80 and over; D002543:Cerebral Hemorrhage / Q000175:diagnosis / Q000209:etiology*; D038524:Diffusion Magnetic Resonance Imaging; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007091:Image Processing, Computer-Assisted; D007674:Kidney Diseases / Q000175:diagnosis / Q000209:etiology*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D059409:Stroke, Lacunar / Q000150:complications*
Cerebral microbleeds; chronic kidney disease; lacunar infarcts; renal dysfunction; small vessel disease; stroke