title: High urinary albumin/creatinine ratio at admission predicts poor functional outcome in patients with acute ischaemic stroke.
abstract: OBJECTIVE
  Albuminuria and a low estimated glomerular filtration rate (eGFR) are widely recognized indices of kidney dysfunction and have been linked to cardiovascular events, including stroke. We evaluated albuminuria, measured using the urinary albumin/creatinine ratio (UACR), and the eGFR in the acute phase of ischaemic stroke, and investigated the clinical characteristics of ischaemic stroke patients with and those without kidney dysfunction.
  
  
  METHODS
  The study included 422 consecutive patients admitted between June 2010 and May 2012. General blood and urine examinations were performed at admission. Kidney dysfunction was defined as a low eGFR (<60 mL/min per 1.73 m2), high albuminuria (≥30 mg/g creatinine), or both. Neurological severity was evaluated using the National Institutes of Health Stroke Scale (NIHSS) at admission and the modified Rankin scale (mRS) at discharge. A poor outcome was defined as a mRS score of 3-5 or death. The impacts of the eGFR and UACR on outcomes at discharge were evaluated using multiple logistic regression analysis.
  
  
  RESULTS
  Kidney dysfunction was diagnosed in 278 of the 422 patients (65.9%). The eGFR was significantly lower and UACR was significantly higher in patients with a poor outcome than in those with a good outcome. In multivariate analyses performed after adjusting for confounding factors, UACR >31.2 mg/g creatinine (OR, 2.58; 95% CI, 1.52-4.43; P = 0.0005) was independently associated with a poor outcome, while a low eGFR was not associated.
  
  
  CONCLUSIONS
  A high UACR at admission may predict a poor outcome at discharge in patients with acute ischaemic stroke.
authors: Department of Nephrology, Nippon Medical School, General Tokyo Hospital.
authors: Yoko
authors: Y
authors: Watanabe
authors: Department of Neurological Science, Graduate School of Medicine, Nippon Medical School, General Tokyo Hospital.
authors: Satoshi
authors: S
authors: Suda
authors: Department of Neurological Science, Graduate School of Medicine, Nippon Medical School, General Tokyo Hospital.
authors: Takuya
authors: T
authors: Kanamaru
authors: Department of Neurological Science, Graduate School of Medicine, Nippon Medical School, General Tokyo Hospital.
authors: Toshiya
authors: T
authors: Katsumata
authors: Department of Neurological Science, Graduate School of Medicine, Nippon Medical School, General Tokyo Hospital.
authors: Seiji
authors: S
authors: Okubo
authors: Department of Nephrology, Nippon Medical School, General Tokyo Hospital.
authors: Tomohiro
authors: T
authors: Kaneko
authors: Department of Nephrology, Nippon Medical School, General Tokyo Hospital.
authors: Akiko
authors: A
authors: Mii
authors: Department of Nephrology, Nippon Medical School, General Tokyo Hospital.
authors: Yukinao
authors: Y
authors: Sakai
authors: Department of Neurological Science, Graduate School of Medicine, Nippon Medical School, General Tokyo Hospital.|Department of Neurology, General Tokyo Hospital.
authors: Yasuo
authors: Y
authors: Katayama
authors: Department of Neurological Science, Graduate School of Medicine, Nippon Medical School, General Tokyo Hospital.
authors: Kazumi
authors: K
authors: Kimura
authors: Department of Nephrology, Nippon Medical School, General Tokyo Hospital.
authors: Shuichi
authors: S
authors: Tsuruoka
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000419:Albuminuria / Q000175:diagnosis* / Q000652:urine; D016022:Case-Control Studies; D003404:Creatinine / Q000652:urine*; D005260:Female; D005919:Glomerular Filtration Rate; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011237:Predictive Value of Tests; D020127:Recovery of Function; D051437:Renal Insufficiency / Q000150:complications / Q000175:diagnosis*; D012307:Risk Factors; D020521:Stroke / Q000150:complications / Q000378:metabolism*
chemical_list: D003404:Creatinine
keywords: acute ischaemic stroke; albuminuria; estimated glomerular filtration rate; prognosis